血清同型半胱氨酸、脂蛋白(a)对维持性血液透析患者自体动静脉内瘘失功的预测价值  

Predictive value of serum homocysteine and lipoprotein(a)in autologous arteriovenous fistula failure in patients undergoing maintenance hemodialysis

作　　者：林超师 何培燕 周秀芬 陈焕红 黄耀辉 LIN Chaoshi;HE Peiyan;ZHOU Xiufen;CHEN Huanhong;HUANG Yaohui(Third Departments of Internal Medicine,Jun'an Hospital Affiliated to Shunde Hospital of Guangzhou University of Traditional Chinese Medicine(Jun'an Hospital of Shunde District,Foshan),Foshan,Guangdong 528329,China;First Department of Internal Medicine,Jun'an Hospital Affiliated to Shunde Hospital of Guangzhou University of Traditional Chinese Medicine(Jun'an Hospital of Shunde District,Foshan),Foshan,Guangdong 528329,China)

机构地区：[1]广州中医药大学顺德医院附属均安医院(佛山市顺德区均安医院)内三科,广东佛山528329 [2]广州中医药大学顺德医院附属均安医院(佛山市顺德区均安医院)内一科,广东佛山528329

出　　处：《国际检验医学杂志》2025年第7期850-855,860,共7页International Journal of Laboratory Medicine

基　　金：佛山市自筹经费类科技创新项目(2220001003909)。

摘　　要：目的 探究血清同型半胱氨酸(HCY)、脂蛋白(a)[Lp(a)]对维持性血液透析(MHD)患者自体动静脉内瘘(AVF)失功的预测价值。方法 选取2022年1-12月该院收治的MHD患者175例作为观察组,无AVF失功的103例患者作为观察1组,AVF失功的72例患者作为观察2组;选取同期来该院门诊体检中心健康体检的175例健康者作为对照组;酶联免疫吸附试验检测HCY、Lp(a)水平;Pearson法分析HCY、Lp(a)与临床指标的相关性;多因素Logistic回归分析MHD患者AVF失功的影响因素;绘制受试者工作特征(ROC)曲线分析血清HCY、Lp(a)对MHD患者AVF失功的预测价值。结果 与对照组相比,观察1组血清HCY、Lp(a)水平升高(P<0.05);与对照组和观察1组相比,观察2组血清HCY、Lp(a)水平升高(P<0.05);观察2组血清HCY、Lp(a)与超滤量呈负相关(P<0.05),HCY、Lp(a)与甲状旁腺激素(PTH)、血磷(P)、尿酸(UA)呈正相关(P<0.05);多因素Logistic回归分析发现,HCY、Lp(a)、PTH、P、UA、糖尿病肾病、内瘘使用时间≥12个月、穿刺点压迫时间≥30 min、前臂动静脉内径<2 mm、管腔狭窄是影响MHD患者AVF失功的危险因素(P<0.05),超滤量是影响MHD患者AVF失功的保护因素(P<0.05);ROC曲线结果显示,HCY、Lp(a)各自单独及联合预测MHD患者AVF失功的曲线下面积分别为0.822、0.820、0.908(Z_(联合vs.HCY)=3.144、Z_(联合vs.Lp(a))=2.925,P<0.05)。结论 AVF失功的MHD患者血清HCY、Lp(a)水平升高,二者是MHD患者AVF失功的影响因素,二者联合预测MHD患者AVF失功的价值较高。Objective To investigate the predictive value of serum homocysteine(HCY) and lipoprotein(a) [Lp(a)] in autologous arteriovenous fistula(AVF) failure in patients undergoing maintenance hemodialysis(MHD).Methods A total of 175 patients with MHD admitted to the hospital from January to December 2022 were selected as the observation group,among them,103 patients without AVF failure were selected as observation group 1,and 72 patients with AVF failure were selected as observation group 2.175 healthy individuals who underwent physical examinations at the outpatient examination center of the hospital during the same period were selected as the control group.Enzyme-linked immunosorbent assay was used to detect the levels of HCY and Lp(a).Pearson method was used to analyze the correlation between HCY,Lp(a) with clinical indicators.Multivariate Logistic regression analysis was performed to analyze the influencing factors of AVF failure in MHD patients.Receiver operating characteristic(ROC) curve was plotted to analyze the predictive value of serum HCY and Lp(a) for AVF failure in MHD patients.Results Compared with the control group,the serum levels of HCY and Lp(a) in observation group 1 were increased(P<0.05).Compared with the control group and observation group 1,the serum levels of HCY and Lp(a) in observation group 2 were increased(P<0.05).The serum levels of HCY and Lp(a) in observation group 2 were negatively correlated with ultrafiltration amount(P<0.05),and HCY and Lp(a) were positively correlated with parathyroid hormone(PTH),blood phosphorus(P),uric acid(UA)(P<0.05).Multivariate Logistic regression analysis showed that HCY,Lp(a),PTH,P,UA,diabetic nephropathy,duration of endovascular fistula use ≥12 months,duration of puncture point compression ≥30 min,and arteriovenous internal diameter <2 mm and vascular stenosis were the risk factors for AVF failure in MHD patients(P<0.05),and ultrafiltration amount was a protective factor for AVF failure in MHD patients(P<0.05).ROC curve results showed that the area under

关 键 词：维持性血液透析 自体动静脉内瘘 失功 预测 

分 类 号：R446.1[医药卫生—诊断学]