颈动脉内中膜厚度与血栓调节蛋白联合检测对血液透析患者并发心血管疾病的预测价值  

Predictive value of carotid intima-media thickness and thrombomodulin for cardiovascular disease in hemodialysis patients

作　　者：王一琳[1] 李声宏[1] WANG Yilin;LI Shenghong(The First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院,江苏苏州215000

出　　处：《山东医药》2019年第1期24-27,共4页Shandong Medical Journal

基　　金：江苏省卫生计生委科研课题(H201561)

摘　　要：目的探讨颈动脉内中膜厚度(c IMT)与血浆血栓调节蛋白(Tm)联合检测对维持性血液透析(MHD)患者并发心血管疾病(CVD)的预测价值。方法 97例透析龄≥3个月的MHD患者,根据随访期间是否发生CVD将其分为CVD组(n=45)和非CVD组(n=52),并于同期随机选取40例体检健康者为对照组。采用劲动脉彩超检测中膜厚度(c IMT),酶联免疫吸附法检测血浆血栓调节蛋白(Tm),以多元Logistic回归分析MHD患者发生CVD的危险因素,受试者工作曲线(ROC)下面积(AUC)评估c IMT、Tm对CVD的预测价值。结果 CVD组c IMT值、血浆Tm水平均高于对照组(P均<0. 05)。BUN、c IMT、Tm是MHD患者发生CVD的独立危险因素(OR分别为1. 449、1. 791、1. 642,P均<0. 05)。c IMT预测MHD患者发生CVD的AUC为0. 869,最佳截断值为1. 73 mm,此时灵敏度、特异度分别为0. 86、0. 77,准确度为0. 82; Tm预测MHD患者发生CVD的AUC为0. 818,最佳截断值为19. 36 mg/L,此时灵敏度、特异度分别为0. 82、0. 71,准确度为0. 76; c IMT联合Tm预测MHD患者发生CVD的AUC为0. 956,灵敏度、特异度分别为0. 93、0. 85,准确度为0. 87。结论 c IMT增厚、血浆Tm水平升高是MHD患者并发CVD的高危因素,二者早期联合检测对预测MHD患者发生CVD的价值较高。Objective To investigate the predictive value of combined detection of carotid intima-media thickness (cI-MT)and plasma thrombomodulin (Tm)for cardiovascular disease (CVD)in maintenance hemodialysis (MHD)patients. Methods Ninety-seven MHD patients with dialysis age≥3 months were divided into the CVD group (n = 45)and non-CVD group (n =52)according to whether CVD occurred during the follow-up period,and 40 healthy persons were random-ly selected as the control group at the same time. The cIMT was examined by carotid ultrasonography,Tm was examined by enzyme linked immunosorbent assay,and Multivariate logistic regression was used to analyze the risk factors of CVD in MHD patients. AUC under ROC was used to evaluate the predictive value of cIMT and Tm for CVD. Results The levels of cIMT and plasma Tm in the CVD group was higher than those in the control group (both P <0.05). BUN,cIMT,and Tm were independent risk factors for CVD in the MHD patients (OR = 1. 449,1. 791,and 1. 642,respectively;all P < 0.05). The AUC of cIMT in predicting CVD of the MHD patients was 0.869 and the best truncation value was 1.73 mm; the sensitivity and specificity were 0.86 and 0.77,respectively,and the accuracy was 0.82. The AUC of Tm in predicting CVD of the MHD patients was 0.818 and the best truncation value was 19. 36 mg/ L;the sensitivity and specificity were 0.82 and 0.71,respectively,and the accuracy was 0.76. The AUC of cIMT combined with Tm in predicting CVD of the MHD patients was 0.956,with the sensitivity and specificity of 0.93 and 0.85,and the accuracy of 0.87,respectively. Conclusion The increased cIMT and increased plasma Tm are high risk factors for CVD in MHD patients,and the early combined detection of them is of high value in predicting CVD for MHD patients.

关 键 词：维持性血液透析 心血管疾病 颈动脉内中膜厚度 血栓调节蛋白 

分 类 号：R459.5[医药卫生—治疗学]