2026 年第 4 期 第 21 卷

血清内皮素1和血管内皮生长因子A水平与慢性肾脏病患者骨量减低的相关性研究

Correlation between serum endothelin-1 and vascular endothelial growth factor A levels and reduced bone mass in patients with chronic kidney disease

作者：高丽1邢瑞生2郭振涛1

英文作者：Gao Li1 Xing Ruisheng2 Guo Zhentao1

单位：1山东第二医科大学附属医院肾内科，潍坊261041；2山东省安丘市人民医院妇科，安丘262100

英文单位：1Department of Nephrology the Affiliated Hospital of Shandong Second Medical University Weifang 261041 China; 2Department of Gynecology Anqiu People′s Hospital Shandong Province Anqiu 262100 China

关键词：慢性肾脏病；内皮素1；血管内皮生长因子A；骨量减低

英文关键词：Chronickidneydisease;Endothelin-1;VascularendothelialgrowthfactorA;Reducedbonemass

• 摘要：

• 目的 探究血清内皮素1、血管内皮生长因子A（VEGF-A）水平与慢性肾脏病患者骨量减低的相关性。方法 回顾性选取山东第二医科大学附属医院2022年1月至2023年1月收治的慢性肾脏病患者362例，依据骨量减低诊断分为骨量减低组（182例）和骨质疏松组（180例），同时选取同期该院健康体检者180例为对照组。比较3组患者血清内皮素1、VEGF-A水平，多因素Logistic回归分析慢性肾脏病患者骨量减低的影响因素，应用Pearson相关性分析慢性肾脏病患者血清内皮素1、VEGF-A水平与骨量减低的相关性。结果 3组高血压病、糖尿病比例、空腹血糖、股骨颈T值、L1~4平均骨密度、血钙、股骨颈骨密度、25-羟基维生素D3［25-（OH）D3］、24 h尿蛋白量、估算肾小球滤过率、血磷、甲状旁腺激素、内皮素1、VEGF-A比较，差异均有统计学意义（均P＜0.05）。在骨量减低组，血清内皮素1、VEGF-A水平与体重指数、高血压病、糖尿病、心血管疾病、甲状旁腺激素、血磷均相关（均P＜0.05）。多因素Logistic回归分析结果显示糖尿病、高血压病、血钙、血磷、25-（OH）D3、甲状旁腺激素、内皮素1、VEGF-A均为慢性肾脏病患者骨量减低的独立影响因素（均P<0.001）。Pearson相关性分析结果显示，慢性肾脏病患者骨量减低与内皮素1呈正相关，与VEGF-A水平呈负相关（r＝0.444、-0.502，均P＜0.001）。结论 血清内皮素1、VEGF-A在慢性肾脏病患者中水平异常，并与患者骨量减低有关，早期监测具有临床意义。

• Objective To investigate the correlation between serum levels of endothelin-1 (ET-1) and vascular endothelial growth factor A (VEGF-A) and reduced bone mass in patients with chronic kidney disease (CKD). Methods A total of 362 CKD patients admitted to the Affiliated Hospital of Shandong Second Medical University from January 2022 to January 2023 were retrospectively enrolled and divided into the reduced bone mass group (182 cases) and the osteoporosis group (180 cases) according to the diagnosis of reduced bone mass. Meanwhile, 180 healthy subjects who underwent physical examination during the same period at this hospital were selected as the control group. Serum levels of ET-1 and VEGF-A were compared among the three groups. Multivariate Logistic regression analysis was used to identify the influencing factors of reduced bone mass in CKD patients, and Pearson correlation analysis was applied to analyze the correlation between serum ET-1 and VEGF-A levels and reduced bone mass in CKD patients. Results There were statistically significant differences in the proportions of hypertension and diabetes, fasting blood glucose, femoral neck T-score, average bone mineral density (BMD) of L1-4, serum calcium, femoral neck BMD, 25-hydroxyvitamin D3［25-（OH）D3］, 24 h urinary protein excretion, estimated glomerular filtration rate (eGFR), serum phosphorus, parathyroid hormone (PTH), ET-1 and VEGF-A among the three groups (all P＜0.05). In reduced bone mass group, serum levels of ET-1 and VEGF-A were correlated with body mass index, hypertension, diabetes, cardiovascular disease, PTH and serum phosphorus (all P＜0.05). Multivariate Logistic regression analysis showed that diabetes, hypertension, serum calcium, serum phosphorus, 25-（OH）D3, PTH, ET-1 and VEGF-A were all independent influencing factors for reduced bone mass in CKD patients (all P<0.001). Pearson correlation analysis revealed that reduced bone mass in CKD patients was positively correlated with ET-1 and negatively correlated with VEGF-A levels (r=0.444, -0.502, both P＜0.001). Conclusionserum levels of ET-1 and VEGF-A are abnormal in CKD patients and associated with reduced bone mass, early monitoring of these indicators has clinical significance.