CORRELATION BETWEEN SERUM BONE MARKERS AND CORONARY ARTERY CALCIUM SCORE IN PATIENTS WITH LOW, INTERMEDIATE AND HIGH CARDIOVASCULAR RISK FACTORS

CILJ ISTRAŽIVANJA. Istražiti odnos između biljega koštanog metabolizam i stupnja kalcifikacije koronarnih arterija kao ključnog čimbenika rizika za srčane bolesti u pacijenata s kroničnom bubrežnom bolesti. U kroničnih bubrežnih bolesnika razvija se i poremećaj koštanog metabolizma i vaskularna kalcifikacija što utječe na povećan rizik od kardiovaskularnih bolesti i smrtnosti. Cilj je istražiti odnos kardiovaskularnog rizika temeljem analize tradicionalnih čimbenika rizika koristeći Framingham procjenu rizika (FRS) s procjenom prema MSCT kalcijskim vrijednostima koronarnih arterija. MATERIJALI I METODE. Sakupljeni su uzorci krvi pacijenata s G4. i G5. stupnjem kronične bubrežne bolesti te od osoba 12 mjeseci nakon uspješne transplantacije bubrega te je izvršena biokemijska analiza seruma. Prikupljeni su anamnestički podaci od pacijenata prema Framingham procjeni rizika. Pacijentima je procijenjena kalcijska vrijednosti koronarnih arterija (CACs) pomoću multidetektorske računalne tomografije. Imunohistokemijskom metodom analizirana je ekspresija BMP-2, BMP-7, OPN, OPG, RANKL, RANK u stijenci arterija s aterosklerozom ili s kalcifikacijom medije. REZULTATI. Koštana alkalna fosfataza (BAP) i kisela fosfataza (TRAP5b) značajno su povišeni u svim skupinama u odnosu na kontrolnu skupinu. PTH je značajno viši u bolesnika u sve tri skupine u odnosu na kontrolnu skupinu. BAP i TRAP5b su značajno viši u bolesnika s visokim razinama PTH bilo u skupini hemodijaliziranih ili među svim ispitanicima. OPG i sRANKL značajno su povišeni u sve tri skupine u odnosu na kontrolnu skupinu. CACs značajno korelira s dobi, s trajanjem dijalize, razinom fosfora i OPG-a u serumu. ZAKLJUČCI. OPG u krvi raste s pogoršanjem kronične bubrežne bolesti i također statistički značajna je korelacija između povišene razine OPG-a u serumu i vrijednosti CACs. Porast razine OPG-a u serumu je značajan biomarker progresije koronarne arterijske kalcifikacije. Prema FRS možemo odrediti razinu kardiovaskularnog rizika, ali rezultati pokazuju da pacijenti sa srednjim rizikom imaju već jako izraženu kalcifikaciju koronarnih arterija.AIM. Investigate the relationship between markers of bone metabolism, especially osteoprotegerin, and the degree of coronary artery calcification as a key risk factor for heart disease in patients with chronic kidney disease. Chronic renal patients also develop a disorder of bone metabolism and vascular calcification, which affects an increased risk of cardiovascular disease and mortality. The aim is to investigate the relationship of cardiovascular risk assessment based on the analysis of traditional risk factors using the Framingham risk score with the assessment according to the analysis of coronary artery calcium score. MATERIAL AND METHODS. Blood samples were collected from patients with stage IV and V of chronic kidney disease and from persons 12 months after successful kidney transplantation. Serum biochemical analysis was performed. Anamnestic data were collected from patients according to the Framingham risk score. Coronary artery calcium score was determined. The expression of BMP-2, BMP-7, OPN, OPG, RANKL, RANK in the arterial wall with atherosclerosis or with calcification of media was analyzed by immunohistochemical method. RESULTS. Bone alkaline phosphatase (BAP) and acid phosphatase (TRAP5b) were significantly elevated in all groups compared to the control group. PTH was significantly higher in patients of all three groups compared to the control group. BAP and TRAP5b were significantly higher in patients with high PTH levels either in the hemodialysis group or among all subjects. OPG and sRANKL are significantly elevated in all three groups compared to the control group. CACs correlates significantly with age, with dialysis duration, serum phosphorus, and OPG levels. CONCLUSIONS. OPG in the blood increases with exacerbation of chronic kidney disease and there is also a statistically significant correlation between elevated serum OPG levels and CACs values. An increase in serum OPG levels is a significant biomarker of coronary arterial calcification progression. According to the FRS, we can determine the level of cardiovascular risk, but data indicate that patients at medium risk already have a very pronounced calcification of the coronary arteries