Association Of Serum Tenascin-C With Bone Mineral Density And Coronary Calcification In Maintenance Hemodialysis Patients

Objective:To investigate the association of serum tenascin-c and bone mineral density,coronary artery calcification?mineral metabolism disorders in maintenance hemodialysis(MHD)patients.Methods:1.73 patients with maintenance hemodialysis were enrolled in the Municipal Hospital Affiliated to Qingdao University from March 2017 to May 2018.22 healthy people in the same period were selected as control group.Serum Tenascin-c level was measured by ELISA,and the difference of Tenascin-c concentration between the two groups was compared.2.Collect the clinical and laboratory examination data of MHD patients,detect the degree of coronary artery calcification by multi-slice spiral C T,measure the lumbar vertebral bone mineral density(BMD)and T value of MHD patients by dual-energy X-ray absorptiometry(DEXA).According to T value,the patients were divided into group A(osteoporosis group,T < 2.5 s),group B(osteopenia group,T between-1.0s and-2.5s),group C(normal bone mass group,T < 2.5 s).The biochemical indexes and serum Tenascin-c levels of the three groups were observed,and the risk factors of lumbar osteoporosis in MHD patients were analyzed.3.Statistical analysis of the correlation between serum Tenascin-c and lumbar BMD,coronary artery calcification and biochemical indicators in MHD patients;Subject Work Curve(ROC)evaluation of Tenascin-c for predicting the risk of lumbar osteoporosis and severe coronary artery calcification(CACs score > 400)in MHD patients.Results:1.The mean value of Tenascin-c in serum of MHD patients was 61.93±4.12ng/ml,which was significantly higher than that of healthy controls 57.32±1.24 ng/ml(t=60.591,P<0.001).2.73 patients with maintenance hemodialysis had moderate to severe coronary artery calcification(CACs score > 100),the incidence rate was 73.97%;10 patients with osteoporosis,the incidence rate was 13.7%,32 patients with bone loss,the incidence rate was 43.8%;Tenascin-c concentration in serum of group A,B and C were(66.80±2.60),(62.63±03.31),(59.65±3.69)ng/ml,respectively,with statistical differences among the three groups.Significance,group A was significantly higher than group B and C(P <0.05),and group B was significantly higher than group C(P < 0.05).Logistic regression analysis showed that Tenascin-c was a risk factor for osteoporosis in MHD patients(P <0.05).3.Pearson correlation analysis:the serum Tenascin-c was positively correlated with iPTH,alkaline phosphatase and CACs in MHD patients(P<0.05),and negatively correlated with serum calcium,albumin and lumbar spine BMD(P<0.05).No significant correlation with blood phosphorus.4.ROC curve analysis: Tenascin-c predicted the area under the curve of lumbar osteoporosis(AUC)was 0.888(P<0.001);Tenascin-c predicted severe coronary artery calcification(AUC)was 0.733(P=0.014).Conclusions: Serum Tenascin-c level increased significantly in MHD Patients.Coronary artery calcification and low bone mineral density were common complications of MHD patients.Serum Tenascin-c level was correlated with iPTH level,lumbar vertebral bone mineral density and coronary artery calcification in MHD patients,which could be used as one of the predictors of CKD-MBD.Detection of serum Tenascin-c level in patients with MHD may provide a new idea for clinical treatment of patients with mineral and bone metabolic disorders(CKD-MBD).