致动脉粥样硬化指数及非高密度脂蛋白胆固醇联合预测血液透析患者血管通路衰竭  

Value of combined atherogenic index of plasma and non-HDL-cholesterol in predicting vascular access failure in hemodialysis patients

作　　者：马丽洁[1] 赵素梅[1] 孙芳[1] 孙倩美[1] MA Li-jie;ZHAO Su-mei;SUN Fang;SUN Qian-mei(Department of Nephrology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肾内科,北京100020

出　　处：《中国血液净化》2023年第5期384-388,共5页Chinese Journal of Blood Purification

摘　　要：目的 探讨致动脉粥样硬化指数(atherogenic index of plasma,AIP)和非高密度脂蛋白胆固醇(non-high density lipoprotein cholesterol,non-HDL-C)与血液透析患者血管通路衰竭(vascular access failure,VAF)的相关性,以及AIP和non-HDL-C对VAF事件的预测价值。方法 纳入2017年1月~2021年12月北京朝阳医院肾内科透析室以自体动静脉内瘘为血管通路的维持性血液透析患者为研究对象(n=277),根据是否发生血管通路功能障碍分为VAF组(n=85)与非VAF组(n=192),比较2组间AIP、non-HDL-C及临床特征的差异。多因素COX回归分析VAF发生的独立危险因素,绘制受试者工作特征曲线,根据AUC评估AIP、non-HDL-C及两者联合模型对血液透析患者VAF发生风险的预测价值。结果VAF组患者AIP(Z=7.331,P<0.001)、non-HDL-C(Z=6.566,P<0.001)较非VAF组高,差异有统计学意义。多因素COX回归矫正性别、年龄、血肌酐、尿酸等因素后提示AIP(HR=8.757,95%CI:4.134~18.548,P<0.001)、non-HDL-C(HR=1.533,95%CI:1.094~2.150,P<0.001)是VAF发生的独立危险因素。AIP预测的AUC为0.776(95%CI:0.722~0.831)、non-HDL-C预测的AUC为0.747(95%CI:0.690~0.805),两者联合模型预测的AUC为0.805(95%CI:0.754~0.855)。结论 AIP、non-HDL-C是维持性血液透析患者VAF事件发生的独立危险因素,两者单独或联合模型对VAF发生风险具有良好的预测价值。Objective To investigate the correlation of atherogenic index of plasma(AIP)and non-high-density lipoprotein cholesterol(non-HDL-C)with the vascular access failure(VAF)in hemodialysis patients,and to evaluate the prediction value of AIP and non-HDL-C for VAF risks.Methods A total of 277 patients on maintenance hemodialysis(MHD)with autologous arteriovenous fistula(AVF)treated in the Dialysis Cen-ter of Beijing Chaoyang Hospital from January 2017 to December 2021 were recruited.They were divided in-to VAF group(n=85)and non-VAF group(n=192).AIP,non-HDL-C and clinical characteristics were com-pared between the two groups.Multivariate COX regression was used to analyze the independent factors for VAF risks.ROC curve was drawn to evaluate the prediction value for VAF risks by AIP and non-HDL-C in MHD patients.Results AIP(Z=7.331,P<0.001)and non-HDL-C(Z=6.566,P<0.001)were statistically high-er in the VAF group than in the non-VAF group.After adjustment for sex,age,blood creatinine and uric acid,AIP(HR=8.757;95%CI:4.134,18.548;P<0.001)and non-HDL-C(HR=1.533;95%CI:1.094,2.150;P<0.001)remained the independent factors for VAF risks.AUC of the prediction for VAF risks by AIP was 0.776(95%CI:0.722,0.831),by non-HDL-C was 0.747(95%CI:0.690,0.805),and by combined both was 0.805(95%CI:0.690,0.805).Conclusions AIP and non-HDL-C are the independent factors for VAF risks.AIP,non-HDL-C or combination of the two have a good predictive value for VAF risks.

关 键 词：血管通路衰竭 血液透析 致动脉粥样硬化指数 非高密度脂蛋白胆固醇 

分 类 号：R459.5[医药卫生—治疗学]