血清sFlt-1、RBP、MFG-E8与慢性肾脏病维持性血液透析患者残余肾功能的相关性及预后预测价值  

Correlation of serum sFlt-1,RBP,and MFG-E8 with residual renal function in patients with chronic kidney disease maintenance hemodialysis and their predictive value for prognosis

作　　者：王朝霞 柴梅月 常淑婷 张立 康娜 贺江花 Wang Chaoxia;Chai Meiyue;Chang Shuting;Zhang Li;Kang Na;He Jianghua(Department of Blood Purification,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Shaanxi Province,Xianyang 712000,China;不详)

机构地区：[1]陕西中医药大学附属医院血液净化科,陕西咸阳712000 [2]陕西中医药大学附属医院肾病一科,陕西咸阳712000

出　　处：《疑难病杂志》2024年第11期1352-1357,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省自然科学基础研究计划项目(2022JQ-786)。

摘　　要：目的研究血清可溶性类fms酪氨酸激酶1(sFlt-1)、视黄醇结合蛋白(RBP)、乳脂球表皮生长因子8(MFG-E8)在慢性肾脏病维持性血液透析患者中表达水平,分析三者与患者残余肾功能(RRF)的相关性及对预后的预测价值。方法选取2020年10月—2023年4月陕西中医药大学附属医院血液净化科收治的慢性肾脏病维持性血液透析患者168例为研究对象,根据残余肾尿素清除率(KRU)计算值分为有RRF组(n=28)和无RRF组(n=140);又根据预后情况分为生存组(n=128)和死亡组(n=40)。收集患者临床资料,采用ELISA检测血清sFlt-1、RBP、MFG-E8水平,Spearman法分析血清sFlt-1、RBP、MFG-E8与RRF的相关性,Logistic回归分析患者预后影响因素,绘制受试者工作特征(ROC)曲线分析血清sFlt-1、RBP、MFG-E8水平对患者预后的预测价值。结果与有RRF组相比,无RRF组的糖尿病患者占比显著增加(χ^(2)/P=7.547/0.006),血清sFlt-1、RBP水平显著升高(t/P=6.870/<0.001、4.449/<0.001),MFG-E8水平显著降低(t/P=14.071/<0.001);血清sFlt-1、RBP与RRF均呈负相关(r=-0.450,-0.562,P<0.05),MFG-E8与RRF呈正相关(r=0.556,P<0.05)。与生存组相比,死亡组血清sFlt-1、RBP水平显著升高(t/P=8.947/<0.001、8.248/<0.001),MFG-E8水平显著降低(t/P=10.040/<0.001);Logistic回归分析结果表明,糖尿病、血清sFlt-1、RBP水平升高为影响患者预后的危险因素[OR(95%CI)=2.336(1.151~4.740)、2.786(1.081~7.180)、2.954(1.171~7.450)],而MFG-E8水平升高为影响患者预后的保护因素[OR(95%CI)=0.788(0.636~0.976)];血清sFlt-1、RBP、MFG-E8以及三者联合预测患者预后的AUC分别为0.834、0.836、0.825、0.925,三者联合预测显著优于各项指标单独预测(Z/P=2.757/0.006、2.804/0.005、3.035/0.002)。结论慢性肾脏病维持性血液透析无RRF患者血清Flt-1、RBP水平显著升高,MFG-E8水平显著降低,与患者RRF具有显著相关性,三者联合检测对患者预后具有一定预测价值。Objective To study the expression levels of serum soluble fms-like tyrosine kinase 1(sFlt-1),retinol-binding protein(RBP),and milk fat globule-epidermal growth factor-factor 8(MFG-E8)in patients with chronic kidney disease maintenance hemodialysis,and to further analyze the correlation between the three with the residual renal function(RRF)of the patients,and their predictive value for prognosis.Methods From October 2020 to April 2023,168 chronic kidney disease maintenance hemodialysis patients admitted to our hospital were regarded as the diseased group,which were separated into the RRF group(n=28)and the no RRF group(n=140)according to the calculated value of RRF,and separated into the survival group(n=128)and the death group(n=40)according to the prognosis.ELISA was applied to detect serum sFlt-1,RBP,and MFG-E8 levels.General clinical data were collected and analyzed.Spearman's method was applied to analyze the correlation between serum sFlt-1,RBP,MFG-E8 and RRF.Logistic regression was performed to analyze the factors affecting patient prognosis.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of serum sFlt-1,RBP,and MFG-E8 levels for prognosis.Results Compared with the RRF group,the proportions of patients with diabetes mellitus in the no RRF group were greatly increased(χ^(2)/P=7.547/0.006),serum sFlt-1 and RBP levels were greatly higher(t/P=6.870/<0.001、4.449/<0.001),and MFG-E8 level was greatly lower(t/P=14.071/<0.001).Serum sFlt-1 and RBP were negatively correlated with RRF(r=-0.450,-0.562,P<0.05),and MFG-E8 was positively correlated with RRF(r=0.556,P<0.05).Compared with the survival group,serum sFlt-1 and RBP levels were greatly higher(P<0.05)and MFG-E8 level was greatly lower(P<0.05)in the death group.Diabetes,elevated serum sFlt-1 and RBP levels were risk factors affecting prognosis(P<0.05),and elevated MFG-E8 level was a protective factor affecting prognosis(P<0.05).The AUC of serum sFlt-1,RBP,MFG-E8,and the combination for predicting prognosis was 0.834,0.

关 键 词：慢性肾脏病 维持性血液透析 残余肾功能 可溶性类fms酪氨酸激酶1 视黄醇结合蛋白 乳脂球表皮生长因子8 预后 

分 类 号：R692[医药卫生—泌尿科学]