标题:维持性血液透析患者血清TM、CD62P、PAF表达水平与血管通路功能的关系
作者:党彦龙,徐玉祥,李江 西电集团医院肾病科,陕西 西安 710077
卷次:
2021年32卷17期
【摘要】 目的 探讨维持性血液透析(MHD)患者血清血栓调节蛋白(TM)、P-选择素(CD62P)、血小板活化因子(PAF)水平与血管通路(VA)功能的关系。方法 选取2017年1月至2020年9月在西电集团医院行MHD的151例尿毒症患者为研究对象,按VA功能情况将患者分为首次行自体动静脉内瘘(AVF)组(48例)、VA正常组(59例)和VA失功(VAF)组(44例)。比较三组患者的一般资料和血清TM、CD62P、PAF水平;Logistic回归分析MHD尿毒症患者发生VAF的影响因素;应用受试者工作特征曲线(ROC曲线)评价血清TM、CD62P、PAF对MHD尿毒症患者发生VAF的诊断价值。结果 VAF组患者的透析时间为(38.56±12.15)个月,明显长于VA正常组的(17.45±8.14)个月,差异有显著统计学意义(P<0.01);VAF组患者血清TM、CD62P、PAF水平分别为(11.16±3.71) ng/mL、(83.98±14.97) ng/mL、(217.52±50.44) pg/mL,明显高于AVF组[分别为(6.38±2.09) ng/mL、(51.02±10.76) ng/mL、(156.61±33.42) pg/mL]和VA正常组[分别为(6.74±2.16) ng/mL、(52.27±10.89) ng/mL、(158.34±33.85) pg/mL],差异均有显著统计学意义(P<0.01);Logistic回归分析结果显示,透析时间、TM、CD62P、PAF均是影响MHD尿毒症患者发生VAF的危险因素(P<0.05);血清TM、CD62P、PAF诊断MHD尿毒症患者发生VAF的曲线下面积(AUC)分别为 0.860、0.867、0.875,截断值分别为 9.39 ng/mL、70.12 ng/mL、198.65 pg/mL,其敏感度分别为 75.0%、77.3%、77.3%,特异性分别为 89.7%、91.6%、90.7%,三者联合诊断MHD尿毒症患者发生VAF的AUC为 0.978,敏感度、特异性分别为 95.5%、88.8%。结论 TM、CD62P、PAF在MHD尿毒症并发VAF患者血清中水平较高,三者联合检测可一定程度提高诊断MHD患者并发VAF的价值。
【关键词】 维持性血液透析;尿毒症;自体动静脉内瘘;血栓调节蛋白;P-选择素;血小板活化因子
【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350(2021)17—2193—04
Relationship between the expression levels of serum TM, CD62P, PAF and vascular access function in uremicpatients with maintenance hemodialysis.
DANG Yan-long, XU Yu-xiang, LI Jiang. Department of Nephrology, XidanGroup Hospital, Xi'an 710077, Shaanxi, CHINA
【Abstract】 Objective To investigate the relationship between the levels of serum thrombomodulin (TM), P-se-lectin (CD62P), platelet activating factor (PAF) and vascular access (VA) function in uremic patients with maintenancehemodialysis (MHD). Methods A total of 151 uremic patients who underwent MHD in Xidian Group Hospital fromJanuary 2017 to September 2020 were selected as the research objects. According to the VA situation, the patients weredivided into the first autogenous arteriovenous fistula (AVF) group (48 cases), the normal group (59 cases) and the VAfailure (VAF) group (44 cases). The general data and the levels of serum TM, CD62P and PAF in the three groups werecompared; logistic regression analysis was used to analyze the influencing factors of VAF in MHD uremic patients; re-ceiver operating characteristic curve (ROC curve) was used to evaluate the diagnostic value of serum TM, CD62P, andPAF in the diagnosis of VAF in patients with MHD uremia. Results The dialysis time of patients in the VAF group was(38.56±12.15) months, which was significantly longer than (17.45±8.14) months of the normal group (P<0.01); serum lev-els of TM, CD62P, and PAF in the VAF group were (11.16±3.71) ng/mL, (83.98±14.97) ng/mL, (217.52±50.44) pg/mL, re-spectively, which were higher than corresponding (6.38±2.09) ng/mL, (51.02±10.76) ng/mL, (156.61±33.42) pg/mL inthe AVF group and corresponding (6.74±2.16) ng/mL, (52.27±10.89) ng/mL, (158.34±33.85) pg/mL in the normal group(all P<0.01); logistic regression analysis results showed that dialysis time, TM, CD62P, PAF were the risk factors of VAFin MHD uremic patients (all P<0.05); the area under the curve (AUC) of serum TM, CD62P and PAF in the diagnosis of VAFin MHD uremic patients was 0.860, 0.867 and 0.875, respectively, and the cut-off value was 9.39 ng/mL, 70.12 ng/mL and198.65 pg/mL, respectively; the sensitivity was 75.0%, 77.3% and 77.3%, respectively, and the specificity was 89.7%,91.6% and 90.7%, respectively; the AUC of the combined diagnosis of VAF was 0.978, and the sensitivity and specifici-ty were 95.5% and 88.8%, respectively. Conclusion The levels of serum TM, CD62P, and PAF are higher in patientswith MHD uremia complicated with VAF. The combined detection of TM, CD62P, and PAF can improve the diagnosticvalue of VAF in patients with MHD uremia to a certain extent.
【Key words】 Maintenance hemodialysis (MHD); Uremia; Autogenous arteriovenous fistula; Thrombomodulin(TM); P-selectin (CD62P); Platelet activating factor (PAF)
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