血清β_(2)-微球蛋白水平对尿毒症维持性血液透析动静脉内瘘失功的诊断价值  

Diagnostic value of serumβ_(2)-microglobulin level for arteriovenous fistula dysfunction in patients with uremia undergoing maintenance hemodialysis

作　　者：谢嘉平 曾莉 XIE Jiaping;ZENG Li(Department of Nephrology,the Second Affiliated Hospital,Chengdu Medical College-416 Hospital of Nuclear Industry,Chengdu 610051)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院肾内科,成都610051

出　　处：《郑州大学学报（医学版）》2024年第2期269-274,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：成都市金牛区肾脏内科专委会专项科研课题(JNQN20-25)。

摘　　要：目的:探讨血清β_(2)-微球蛋白(β_(2)-MG)水平对尿毒症维持性血液透析动静脉内瘘失功的诊断价值。方法:选取2019年1月至2022年4月我院采用动静脉内瘘为血管通路进行维持性血液透析治疗的患者202例,根据动静脉内瘘功能分为失功组(48例)和对照组(154例)。采集患者上机前外周静脉血,采用Immulite 2000全自动化学发光免疫分析仪检测血清β_(2)-MG水平,同时检测其他实验室指标如血浆超敏-C反应蛋白(hs-CRP)、血浆D-二聚体(D-D)水平等。行肱动脉超声检查,观察血管壁钙化、血栓形成情况,计算肱动脉血流量、搏动指数和阻力指数。采用Logistic回归分析动静脉内瘘失功的影响因素。绘制ROC曲线,分析β_(2)-MG对动静脉内瘘失功的诊断价值。结果:失功组血hs-CRP、D-D和β_(2)-MG水平均高于对照组(P<0.05);失功组肱动脉血流量低于对照组,肱动脉搏动指数、阻力指数和血管壁钙化、血栓形成发生率高于对照组(P<0.05)。Logistic回归分析结果显示血清β_(2)-MG水平、肱动脉血流量和肱动脉阻力指数为动静脉内瘘失功的影响因素,OR(95%CI)分别为1.446(1.211~1.726)、0.994(0.991~0.996)、1.158(1.034~1.298)。血清β_(2)-MG水平诊断维持性血液透析动静脉内瘘失功的ROC曲线下面积(95%CI)为0.705(0.654~0.864),以15.81 mg/L为截断值时敏感度为0.75,特异度为0.63。结论:血清β_(2)-MG水平是维持性血液透析动静脉内瘘失功的重要影响因素,对判断动静脉内瘘失功具有一定参考价值。Aim:To explore the diagnostic value of serumβ_(2)-microglobulin(β_(2)-MG)level for arteriovenous fistula(AVF)dysfunction in patients with uremia undergoing maintenance hemodialysis(MHD).Methods:Totally 202 patients who were treated with MHD by taking AVF as vascular access in our hospital from January 2019 to April 2022 were selected.According to the function of AVF,the patients were allocated into dysfunction group(n=48)and control group(n=154).The peripheral blood sample was collected and serumβ_(2)-MG was determined by Immulite 2000 automatic chemiluminescence immunoassay analyzer,and other indexes such as plasma high-sensitivity C-reactive protein(hs-CRP),D-dimer,etc were determined.Brachial artery Doppler ultrasound examination was performed,the vascular wall calcification and thrombosis were observed,and brachial artery blood flow volume,the brachial artery pulsatility index,resistance index were calculated.Logistic regression analysis was used to study the influencing factors of AVF dysfunction.ROC curve was drawn to analyze the diagnostic value ofβ_(2)-MG on AVF dysfunction.Results:The levels of plasma hs-CRP,D-dimer and serumβ_(2)-MG in dysfunction group were higher than those in control group(P<0.05).The brachial artery blood flow volume in dysfunction group was less compared with that in control group,while the brachial artery pulsatility index,resistance index and incidence rates of vascular wall calcification and thrombosis were higher(P<0.05).Logistic regression analysis showed that serumβ_(2)-MG,brachial artery blood flow volume and resistance index were the influencing factors of AVF dysfunction[OR(95%CI)were 1.446(1.211-1.726),0.994(0.991-0.996),1.158(1.034-1.298),all P<0.05].The area under curve(95%CI)of serumβ_(2)-MG in diagnosing AVF dysfunction in patients with uremia undergoing MHD was 0.705(0.654-0.864),and the sensitivity and specificity were 0.75 and 0.63 with the cutoff value of 15.81 mg/L.Conclusion:Serumβ_(2)-MG level is an important influencing factor of AVF dysfunction in ure

关 键 词：尿毒症 维持性血液透析 β_(2)-微球蛋白 动静脉内瘘 失功 

分 类 号：R459.5[医药卫生—治疗学]