维持性血液透析患者的血浆可溶性尿激酶型纤溶酶原激活物受体与冠脉钙化及心血管事件的关系  

Soluble urokinase plasminogen activator receptor is associated with coronary aretery calcification and cardiovascular events in maintenance hemodialysis patients

作　　者：伍文娟[1,2] 崔燕海[3] 黎思嘉 徐丽霞[2] 陈源汉[2] 莫立仪 田秀兰[2] 张丽[2] 李卓[2] 王力芬[2] 梁华般[2] 李锐钊[2] 叶智明[2] 史伟[2] 梁馨苓[2] 刘双信[1,2] 

机构地区：[1]南方医科大学,广州510515 [2]广东省人民医院(广东省医学科学院)肾内科 [3]广东省人民医院(广东省医学科学院)放射科

出　　处：《肾脏病与透析肾移植杂志》2017年第1期26-30,43,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家临床重点专科建设项目;国家自然科学基金项目(81670665);广东省自然科学基金(2014A030313544);广州市科技计划项目(201605110852556)

摘　　要：目的:探讨维持性血液透析(MHD)患者的血浆可溶性尿激酶型纤溶酶原激活物受体(suPAR)与冠脉钙化、心血管事件与死亡的关系。方法:在2010年至2016年期间随访99例MHD患者,用ELISA方法检测血浆suPAR,用64层螺旋CT(MDCT)测定冠状动脉钙化积分(CACS),分析suPAR与CACS的关系,及其对心血管事件发生率和全因死亡的影响。结果:2010年~2016年,91例(91.9%)存在不同程度的血管钙化,Spearman相关分析中,suPAR与冠状动脉钙化程度呈正相关(P=0.001,r=0.315),与CACS<100分组比较,CACS≥100分组血浆suPAR显著提高(P=0.048)。根据血浆suPAR的四分位数进行分析,发现高suPAR组心血管事件和全因死亡率最高(P<0.05)。单因素COX回归分析中,suPAR是心血管事件和全因死亡的危险因素;多因素COX回归模型显示suPAR仍然是心血管事件发生的独立危险因素。结论:在MHD患者中,suPAR与冠状动脉钙化程度呈正相关,suPAR作为心血管事件发生的独立危险因素,对MHD患者心血管事件的发生有一定的预测作用。Objective： To investigate the associations between soluble urokinase plasminogen activator receptor（ suPAR） and coronary aretery calcification and clinical outcomes in maintenance hemodialysis patients. Methodology： A total of 99 adult hemodialysis patients were enrolled in this study. Plasma samples were analyzed for suPAR by ELISA and coronary aretery calcification score（ CACS） was detected by MDCT. Occurrences of new on-set cardiovascular events and all-cause mortality were examined until 1st June 2016. The association of suPAR to CACS was evaluated by Bivariate and risk factors of mortality were identified with a multivariate COX proportional hazard model. Results： Of the 99 MHD patients,91（ 91. 9%） had varying degrees of CAC. Su PAR was positively correlate with CAC Score using Spearman analysis（ P = 0. 001,r = 0. 315）. In comparison with the CACS〈100 group,suPAR was higher in the CACS≥100 group（ P = 0. 048）. Quartiles of suPAR were employed as the cutoff point for subgroup analysis,the incidence of CVD and allcause mortality was much higher in the higher quartiles of suPAR. In the univariate COX regression analysis,higher suPAR is a risk factor of CVD and all-cause mortality. In the COX proportional hazards model after adjustment for multi-factors,suPAR remained an independent factor of CVD. Conclusion： suPAR is associated with CACS core and show a clear,graded association with a higher risk for new on-set cardiovascular disease in MHD patients.

关 键 词：血液透析 可溶性尿激酶型纤溶酶原激活物受体 血管钙化 心血管疾病 

分 类 号：R692.5[医药卫生—泌尿科学] R54[医药卫生—外科学]