血浆ADAMTS-13联合Gas6对维持性血液透析尿毒症患者AVF血栓的预测价值研究  

Predictive value of plasma ADAMTS-13 combined with Gas6 for AVF thrombosis in uremia patients undergoing maintenance hemodialysis

作　　者：张悦 张效功 米爱红 张宏涛[2] Zhang Yue;Zhang Xiaogong;Mi Aihong;Zhang Hongtao(The Third People's Hospital of Henan Province,Zhengzhou 450000,Henan,China;不详)

机构地区：[1]河南省直第三人民医院,河南郑州450000 [2]河南省人民医院,河南郑州450003

出　　处：《临床心身疾病杂志》2024年第3期46-50,共5页Journal of Clinical Psychosomatic Diseases

基　　金：河南省医学科技攻关计划联合共建项目(编号LHGJ20190613)。

摘　　要：目的探讨血浆血管性血友病因子裂解酶(ADAMTS-13)联合生长停滞特异性蛋白(Gas6)预测维持性血液透析(MHD)尿毒症患者自体动静脉内瘘(AVF)血栓的价值。方法回顾性分析148例以AVF为通路行MHD治疗的尿毒症患者的临床资料,并统计患者出院1 a内AVF血栓发生情况。对MHD尿毒症患者AVF血栓的影响因素进行单因素分析及多因素Logistic回归分析,绘制受试者工作特征(ROC)曲线分析血浆ADAMTS-13、Gas6及两者联合对MHD尿毒症患者AVF血栓的预测价值。结果出院1 a内,148例MHD尿毒症患者发生AVF血栓31例(20.95%)。发生AVF血栓组C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及血浆Gas6水平显著高于未发生组,铁蛋白及血浆ADAMTS-13水平显著低于未发生组(P<0.05或0.01)。Logistic回归分析显示,CRP、TNF-α、IL-6、血浆ADAMTS-13、血浆Gas6水平均是MHD尿毒症患者AVF血栓的影响因素(P<0.05或0.01)。ROC曲线显示,两者联合预测MHD尿毒症患者AVF血栓的曲线下面积(AUC)为0.836,高于血浆ADAMTS-13、Gas6单独预测的0.793和0.780。结论血浆ADAMTS-13、Gas6联合预测MHD尿毒症患者AVF血栓的效能较高。Objective To explore the value of plasma vascular haemophilia factor lyase(ADAMTS-13)combined with growth arrest specific protein(Gas6)in predict ing thrombosis of autogenous arteriovenous fistula(AVF)in uremia patients undergoing maintenance hemodialysis(MHD).Methods Clinical data of 148 uremia patients undergoing the MHD via the AVF were retrospectively analyzed and the occurrence of AVF thrombosis within 1 year after discharge was counted.Influencing factors of AVF thrombosis in uremia patients undergoing the MHD were analyzed using univariate analysis and multiple Logistic regression analysis,the receiver operating characteristic(ROC)curves plotted to analyze the predictive value of plasma ADAMTS-13,Gas6,and their combination for AVF thrombosis in uremia patients undergoing the MHD.Results Of 148 uremia patients undergoing the MHD,31(20.95%)developed AVF thrombosis within 1 year after discharge.C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and plasma Gas6 in patients with AVF thrombosis were significantly higher,while the levels of fer ritin and plasma ADAMTS-13 were significantly lower(P<0.05 or 0.01).Logist ic regression analysis showed CRP,TNF-α,IL-6 as well as plasma ADAMTS-13 and Gas6 levels were inf luencing factors of AVF thrombosis in uremia patients undergoing the MHD(P<0.05 or 0.01).ROC curve showed that the AUC of AVF thrombosis in MHD uremia patients was 0.836,which was higher than 0.793 and 0.780 predicted by ADAMTS-13 and Gas6 alone.Conclusion The efficacy of combined ADAMTS-13 and Gas6 predicting AVF thrombosis in uremia patients undergoing the MHD is higher.

关 键 词：尿毒症 维持性血液透析 血管性血友病因子裂解酶 生长停滞特异性蛋白 自体动静脉内瘘 血栓 预测价值 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]