维生素K2与维持性血液透析患者血管钙化相关性研究

目的：探讨维生素K2与维持性血液透析(MHD)患者血管钙化的关系。方法收集2014年1月至2015年10月在广西医科大第四附属医院血透，透析龄≥3年患者资料。根据入选条件筛选出60例患者(研究组)，用X线平片对骨盆、双手进行血管钙化的定量测量，按血管钙化评分情况分为＜4分组和≥4分组。另选取60例年龄及性别与研究组相仿的健康人为对照组。完善血清维生素K2、血清钙(Ca)、血清磷(P)、全段甲状旁腺激素(iPTH)等指标，采用t检验、Spearman相关分析、Logistic回归分析进行统计学分析。结果研究组患者中有34例出现不同程度、不同部位血管钙化，钙化发生率为56.67%；研究组患者的维生素K2水平较对照组明显降低(2.46±0.93) vs (4.17±1.04) nmol/L，t=5.652，P<0.01]；血管钙化评分≥4分组患者维生素K2水平明显低于<4分组患者(1.99±0.77) vs (2.56±0.93) nmol/L，t=1.837，P<0.05]；Spearman相关分析显示维生素K2与血管钙化积分呈负相关(γ=-0.276，P<0.05)；与钙、磷、钙磷乘积、iPTH无相关性(P>0.05)。多项Logistic回归分析显示维生素K2是血管钙化的独立影响因素。结论 MHD患者普遍存在血管钙化和维生素K2缺乏，维生素K2水平是血管钙化的独立影响因素。

Correlation study of Vitamin K2 and vascular calcification in patients on maintenance hemodialysis

Objective To study the relationship between vitamin K2 and vascular calcification in patients on maintenance hemodialysis. Methods The clinical data of patients who received maintenance hemodialysis in the Fourth Affiliated Hospital of Guangxi Medical University from January 2014 to October 2015 and whose dialysis ages were longer than 3 years were collected. Sixty patients were screened according to the conditions above (the study group). They accepted quantitative measurement of vascular calcification on pelvis and both hands by X-ray and were di-vided into <4 points group and ≥4 points group based on the measurement. Sixty healthy subjects at similar age and with the same gender were selected as control group. Serum Vitamin K2, serum calcium (Ca), serum phosphorus (P) and intact parathyroid hormone (iPTH) were determined and analyzed by using t test, Spearman correlation analysis and lo-gistic regression analysis. Results There were 34 cases of vascular calcification of different degree and different parts in study group, and the occurrence rate of calcification was 56.67%. Vitamin K2 level of the study group was significant-ly lower than that of the control group (2.46 ± 0.93) nmol/L vs (4.17 ± 1.04) nmol/L, t=5.652, P<0.01]. Vitamin K2 level of≥4 points group was significantly lower than that of<4 points group (1.99±0.77) nmol/L vs (2.56±0.93) nmol/L, t=1.837, P<0.05]. Spearman correlation showed that vitamin K2 had a negative correlation with vascular calcification score and had no correlation with calcium, phosphorus, calcium-phosphorus product, ipTH (P>0.05). Many items of logistic re-gression showed that vitamin K2 was the independent factor affecting vascular calcification. Conclusion Vascular calci-fication and the lack of vitamin K2 are ubiquitous in MHD patients. Vitamin K2 level is the independent factor affecting vascular calcification.