摘要
目的探讨血清骨硬化蛋白(SOST)、成纤维细胞因子-23(FGF-23)、可溶性CD40配体(sCD40L)联合检测对维持性血液透析(MHD)病人并发心血管事件的预测价值。方法选取2017年1月至2019年3月中国人民解放军第305医院收治的行MHD的149例病人作为研究对象,根据MHD病人有无心血管事件发生将其分为未发生组和发生组,另选取同期128例健康体检者设为对照组。比较各组SOST、FGF-23、sCD40L,找出影响MHD病人并发心血管事件的危险因素。结果MHD病人心血管事件发生率为33.56%,发生组年龄(59.11±10.74)岁、血肌酐(Scr)(849.07±156.81)μmol/L及血清SOST(119.83±22.78)pmol/L、FGF-23(569.07±92.84)ng/L、sCD40L(119.49±23.86)μg/L水平均高于未发生组和对照组,均差异有统计学意义(P<0.05),未发生组Scr(753.73±112.06)mol/L及血清SOST(86.23±16.05)pmol/L、FGF-23(439.14±78.02)ng/L、sCD40L(82.02±15.53)μg/L水平均高于对照组,均差异有统计学意义(P<0.05);MHD病人血清SOST水平与钙(Ca)呈正相关(P<0.05),血清FGF-23水平与磷(P)呈正相关(P<0.05);年龄大、收缩压高、透析时间长、高水平的尿酸(UA)、血肌酐(Scr)、胱抑素C(Cys-C)、超敏C反应蛋白(hs-CRP)、三酰甘油(TG)与高水平的SOST、FGF-23、sCD40L均为是影响MHD病人并发心血管事件的危险因素(P<0.05);血清SOST、FGF-23、sCD40L水平联合预测MHD病人并发心血管事件的灵敏度和曲线下面积(AUC)分别为98.00%和0.96,均高于单一指标评价(P<0.01)。结论血清SOST、FGF-23、sCD40L水平升高均是MHD病人并发心血管事件的危险因素,以上三项指标均对MHD病人并发心血管事件有较好的预测价值,但三者联合预测时的价值更高。
Objective To explore the predictive value of the combination of serum sclerostin(SOST)protein,fibroblast growth factor-23(FGF-23)and soluble CD40 ligand(sCD40L)on cardiovascular events in maintenance hemodialysis(MHD)patients.Methods A total of 149 MHD patients admitted to the 305 Hospital of the Chinese People's Liberation Army(PLA)in January 2017 to March 2019 were selected for the study.The patients were divided into a nonoccurrence group and an occurrence group according to the presence or absence of cardiovascular events,and 128 healthy patients were selected as the control group during the same period.SOST,FGF-23 and sCD40L were compared among the groups to determine the risk factors affecting the complications of cardiovascular events in MHD patients.Results The incidence of cardiovascular events in MHD patients was 33.56%,and the age(59.11±10.74)years,serum creatinine(Scr)(849.07±156.81)μmol/L and serum SOST(119.83±22.78)pmol/L,FGF-23(569.07±92.84)ng/L,and sCD40L(119.49±23.86)μg/L levels were higher than those in the nonoccurrence group and the control group(P<0.05).The levels of Scr(753.73±112.06)μmol/L,SOST(86.23±16.05)pmol/L,FGF-23(439.14±78.02)ng/L and sCD40L(82.02±15.53)μg/L in the nonoccurrence group were higher than those in the control group(P<0.05).The serum SOST levels were positively correlated with calcium(Ca)and serum FGF-23 levels were positively correlated with phosphorus(P)in MHD patients(P<0.05).Older age,high systolic blood pressure,longer dialysis time,higher levels of uric acid(UA),Scr,cystatin C(Cys-C),hypersensitive C-reactive protein(hs-CRP),and triglycerides(TGs)and higher levels of SOST,FGF-23,and sCD40L were all risk factors for concurrent cardiovascular events in MHD patients(P<0.05).The sensitivity and area under the curve(AUC)of combined serum SOST,FGF-23 and sCD40L levels in predicting concurrent cardiovascular events in MHD patients were 98.00%and 0.96,respectively,which were higher than those evaluated by a single index(P<0.01).Conclusions The elevated levels of serum SOST,FGF-23 and sCD40L are all risk factors for concurrent cardiovascular events in MHD patients.All three of these indicators have good predictive value for concurrent cardiovascular events in patients with MHD,but the value is higher when the three are combined.
作者
陈东
蒋知新
张洁
祝丙华
CHEN Dong;JIANG Zhixin;ZHANG Jie;ZHU Binghua(Department of Nephrology,305 Hospital of the Chinese People's Liberation Army,Beijing 100017,China;Central Laboratory,305 Hospital of the Chinese People's Liberation Army,Beijing 100017,China;Infection Control,305 Hospital of the Chinese People's Liberation Army,Beijing 100017,China)
出处
《安徽医药》
CAS
2023年第2期291-296,共6页
Anhui Medical and Pharmaceutical Journal
