接受血液透析之末期腎臟病患者的Osteopontin與代謝指標之關聯性探討

The Correlation of Osteopontin and Metabolic Markers in Patients with End Stage Renal Disease Receiving Hemodialysis

葉哲廷(Jeo-Ting Yeh)

指導教授 ： 張浤榮

中山醫學大學/醫學院/醫學研究所/碩士(2018年)

摘要

研究背景：骨橋蛋白(Osteopontin, OPN)被認為和粥狀動脈硬化的形成相關，在發炎反應及血管鈣化也扮演重要角色，同時OPN也和代謝異常，例如糖尿病以及肥胖相關。根據目前文獻資料顯示，OPN在末期腎臟病扮演何種角色並無定論。
研究目的：探究末期腎臟病接受血液透析族群，其血漿中OPN與各項代謝指標之關係。
研究方法：自2007年12月起，至2012年12月為止，一共收納151位常規血液透析患者進行研究。血液標本於執行血液透析前採樣，量測各項生化值，同時以酵素免疫分析法(Enzyme Linked Immunosorbent Assay, ELISA)測量OPN。患者以老人營養風險指標(Geriatric Nutritional Risk Index, GNRI)評估營養狀況。以線性回歸分析OPN和各項生化值及老人營養風險指標之相關性。
研究結果：患者所測得之血漿中OPN的平均值為21.355 ± 41.02 ng/mL。以次族群分析發現OPN和年齡、性別、是否有糖尿病或高血壓等皆無相關，但與透析模式(high flux vs low flux dialysis)、白蛋白、總膽固醇及老人營養風險指標相關。以線性回歸分析經調整年齡、性別、身體質量指數、膽固醇、尿酸、肌酐酸、血磷、透析模式，以及老人營養風險指標等參數之後，發現OPN和老人營養風險指標(r = -0.2, p = 0.019)、總膽固醇(r = -0.186, p = 0.029)，以及尿酸(r = -0.169, p = 0.048)三者呈負相關。
結論：血液透析患者的血漿中OPN和營養指標呈現負相關。

關鍵字

末期腎臟病 ； 血液透析 ； 骨橋蛋白 ； 老人營養風險指標

並列摘要

Background: Osteoponin (OPN) plays an important role in atherosclerosis, participates in acute and chronic inflammation, and can inhibit vascular calcification. OPN is related to metabolic disorders such as obesity or diabetes. The metabolic effects of OPN were not clear in patients with end stage renal disease (ESRD) patients receiving hemodialysis (HD).
Methods: 151 HD patients were enrolled to the study during the time frame starting from December 2007 to December 2012. The blood samples were collected measuring the biochemistry data. OPN was measured by enzyme linked immunosorbent assay (ELISA). The Geriatric Nutritional Risk Index (GNRI) score was calculated to evaluate nutrtional status. Stastical analysis by linear regression was performed to access the correlation of OPN to biochestry and GNRI score.
Results: The mean concentration of osteopontin is 21.355 ± 41.02 ng/mL. By subgroup analysis, OPN was not related to age, gender, diabetes, or hypertension. HD Patients who received high flux dialysis had lower OPN level compared to low flux. In addition, lower OPN was found in HD patients with higher albumin, higher total cholesterol level, and higher GNRI score. After stepwise multivariate linear correlation analysis adjusted by age, gender, body mass index, cholesterol, uric acid, creatinine, phosphate, mode of dialysis and GNRI score, osteopontin level was negative correlated with GNRI score (r = -0.2, p = 0.019), total cholesterol (r = -0.186, p = 0.029), and uric acid (r = -0.169, p = 0.048).
Conclusions: OPN is neagtively associated with nutritional markers such as albumin, total cholesterol, uric acid, and GNRI score in ESRD patients receiving hemodialysis.

並列關鍵字

End stage renal disease (ESRD) ； Hemodialysis (HD) ； Osteopontin (OPN) ； Geriatric Nutritional Risk Index (GNRI) score

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