外周血组织蛋白酶水平对维持性血液透析患者动静脉内瘘狭窄及尿激酶联合阿加曲班治疗效果的预测价值分析  

Predictive value of cathepsin level in peripheral blood on arteriovenous fistula stenosis and therapeutic effect of urokinase combined with argatroban in patients with maintenance hemodialysis

作　　者：刘淑婷 冯季[1] 杨亚琴 Liu Shuting;Feng Ji;Yang Yaqin(Department of Blood Purification,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院血液净化科,张家口075000

出　　处：《中国医师进修杂志》2023年第3期225-229,共5页Chinese Journal of Postgraduates of Medicine

基　　金：河北省医学科学研究重点课题计划(20180884)。

摘　　要：目的研究外周血组织蛋白酶(Cat)水平对维持性血液透析(MHD)患者动静脉内瘘狭窄及尿激酶联合阿加曲班治疗效果的预测价值。方法回顾性分析河北北方学院附属第一医院2017年1月至2021年1月120例MHD患者的临床资料。其中,发生动静脉内瘘狭窄72例(狭窄组),未发生动静脉瘘狭窄48例(未狭窄组)。发生动静脉内瘘狭窄患者采用尿激酶联合阿加曲班治疗,并评价治疗效果;通过数字减影血管造影(DSA)检查评估动静脉内瘘狭窄程度。采用酶联免疫吸附法检测外周血Cat K和S水平。绘制受试者工作特征(ROC)曲线,评价外周血Cat K和S水平对MHD患者发生动静脉内瘘狭窄的预测价值;采用多因素Logistic回归分析影响MHD患者发生动静脉内瘘狭窄的独立危险因素。结果狭窄组外周血Cat K和S水平明显高于未狭窄组[(404.34±12.43)μg/L比(344.22±12.09)μg/L和(124.55±13.43)μg/L比(84.60±12.45)μg/L],差异有统计学意义(t=26.39和16.68,P<0.01)。DSA检查结果显示,动静脉内瘘轻度狭窄33例,中度狭窄23例,重度狭窄16例。中度狭窄和重度狭窄患者外周血Cat K和S水平明显高于轻度狭窄患者[(399.83±11.79)和(476.27±12.24)μg/L比(372.61±12.88)μg/L、(125.77±12.75)和(151.69±11.86)μg/L比(110.54±12.07)μg/L],重度狭窄患者明显高于中度狭窄患者,差异有统计学意义(P<0.01)。治疗效果评价结果显示,显效40例,有效23例,无效9例。有效和无效患者外周血Cat K和S水平明显高于显效患者[(404.78±10.96)和(491.30±10.26)μg/L比(384.52±10.36)μg/L、(121.85±10.99)和(232.65±10.61)μg/L比(101.78±10.61)μg/L],无效患者明显高于有效患者,差异有统计学意义(P<0.01)。ROC曲线分析结果显示,外周血Cat K联合Cat S预测MHD患者发生动静脉内瘘狭窄的曲线下面积明显大于Cat K和S的单独检测(0.699比0.635和0.611),准确率和特异度也明显升高(80.83%比48.33%和60.00%、89.58%比76.25%和81.33%),外周血Cat K�Objective To study the predictive value of peripheral blood cathepsin(Cat)level on arteriovenous fistula stenosis and therapeutic effect of urokinase combined with argatroban in patients with maintenance hemodialysis(MHD).Methods The clinical data of 120 patients with MHD from January 2017 to January 2021 in the First Affiliated Hospital of Hebei North University were retrospectively analyzed.Among them,72 patients had arteriovenous fistula stenosis(stenosis group),and 48 patients had not arteriovenous fistula stenosis(non-stenosis group).The patients in stenosis group were treated with urokinase combined with argatroban,and the therapeutic effect was evaluated;the stenosis degree of arteriovenous fistula stenosis was evaluated by digital subtraction angiography(DSA).The levels of Cat K and S in peripheral blood were detected by enzyme linked immunosorbent assay.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of Cat K and S in peripheral blood on arteriovenous fistula stenosis in patients with MHD.The independent risk factor of arteriovenous fistula stenosis in patients with MHD was analyzed by multivariate Logistic regression analysis.Results The levels of Cat K and S in peripheral blood in stenosis group were significantly higher than those in non-stenosis group:(404.34±12.43)μg/L vs.(344.22±12.09)μg/L and(124.55±13.43)μg/L vs.(84.60±12.45)μg/L,and there were statistical differences(t=26.39 and 16.68,P<0.01).The result of DSA showed that mild stenosis of arteriovenous fistula stenosis was in 33 cases,moderate stenosis in 23 cases,and severe stenosis in 16 cases.The levels of Cat K and S in peripheral blood in patients with moderate stenosis and severe stenosis were significantly higher than those in patients with mild stenosis:(399.83±11.79)and(476.27±12.24)μg/L vs.(372.61±12.88)μg/L,(125.77±12.75)and(151.69±11.86)μg/L vs.(110.54±12.07)μg/L,the indexes in patients with severe stenosis were significantly higher than those in patients with moderate steno

关 键 词：透析 动静脉瘘 组织蛋白酶类 血栓溶解疗法 尿激酶 阿加曲班 

分 类 号：R692.5[医药卫生—泌尿科学]