缺血修饰白蛋白对腹膜透析患者心血管事件的预测  

Predictive value of ischemia modified albumin for cardiovascular events in patients on peritoneal dialysis

作　　者：苏晓燕[1] 黄辉[2] 张坤[2] 郑伟平[1] 李爱婷[1] 关晓东[1] 彭洪泉[3] 

机构地区：[1]中山大学附属东华医院肾内科,东莞523110 [2]中山大学孙逸仙纪念医院心内科 [3]澳门镜湖医院肾内科

出　　处：《肾脏病与透析肾移植杂志》2013年第1期38-42,69,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(81170647);东莞市科技计划医疗卫生类科研一般项目(201210515000387)

摘　　要：目的:评价缺血修饰白蛋白(IMA)对腹膜透析(PD)患者主要不良心血管事件(MACE)的预测价值。方法:选取行PD治疗>3月的终末期肾病患者120例,收集患者的基础资料、IMA及各项实验室指标,并对相关指标进行分析。结果:随访期间发生MACE患者即为MACE组共38例,未发生MACE者即为non-MACE组共82例。MACE组患者IMA水平较高[(90.14±12.88)KU/Lvs(77.54±12.47)KU/L,P<0.0001],血糖水平、肌钙蛋白T(cTnT)水平、超敏C反应蛋白(hs-CRP)亦较高,而血清白清白、总肌酐清除率、残余肾功能则较低。logistic回归分析显示IMA、hs-CRP是心血管事件发生的独立危险因素,优势比分别为1.27、1.05。IMA曲线下面积为0.77(95%CI0.69～0.84,P<0.05),最佳截值85.56KU/L,灵敏度73.68%,特异度78.05%。cTnT曲线下面积为0.72(95%CI0.63～0.79,P<0.05),最佳截值46.75pg/ml,灵敏度64.86%,特异度73.17%。结论:IMA是PD患者发生MACE的独立危险因素,其可作为PD患者MACE的预测指标。Objective： To evaluate the predictive value of ischemia modified albumin （IMA） for major adverse cardiovascular events （MACE） in patients on peritoneal dialysis. Methodology：A total of one hundred twenty end stage renal disease patients on peritoneal dialysis over 3 months were enrolled. According to whether or not suffering MACE, they were divided into MACE group （ n = 38 ） and non - MACE group （ n = 82 ）. The baseline characteristics, IMA levels and other laboratory measurements were collected and analyzed. Resalts：They were 74 males and 46 females with an average age of （44. 2±14. 6） years old. Their original diseases were primary glomerulonephritis in 80,diabetic nephropathy in 15 ,hypertensive glomerulosclerosis in 11 ,urate nephmpathy in 5 ,obstructive nephropathy in 5,lupus nephritis in 2, purpura nephritis in one and nephritis associated with hepatitis B in one case. The patients in MACE group had significantly higher IMA levels [ （90. 1 ±12. 9） KU/L vs （77.5±12.5） KU/L P 〈 0. 0001 ） 1, glucose levels, cardiac troponin T （cTnT） levels, and high sensitivity C-reactive protein （hs-CRP） ,while lower serum albumin level,total creatinine clearance,and residual GFR （rGFR）. Muhivariable logistic regression analysis showed that IMA and hs-CRP were independent risk factors for MACE. From ROC （receiver operating characteristic） curve analysis,the optimal cut-off of IMA to predict MACE was 85. 6 KU/L,with a sensitivity of 73. 7% and a specificity of 78. 1% [ area under the curve ,0. 77 （95% confidence interval,0. 69-0. 84） ;P 〈 0.05 ]. The optimal cut-off of cTnT to predict MACE was 46. 8 pg/ml, with a sensitivity of 64. 9% and a specificity of 73. 2% [ area under the curve,0. 72 （95% confidence interval,0. 63 -0. 79） ;P 〈0. 05]. The difference of AUC between IMA and cTnT was not significant ,Z =0. 92, P =0. 36. Conclusiou：IMA is an independent risk factors for the occurrence of MACE in patients on peritoneal dialysis, and can be used as a predic

关 键 词：腹膜透析 缺血修饰白蛋白 主要不良心血管事件 

分 类 号：R692.5[医药卫生—泌尿科学]