颈动脉内中膜厚度与血栓调节蛋白联合检测对血液透析患者并发心血管疾病的预测价值
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摘要
目的探讨颈动脉内中膜厚度(c IMT)与血浆血栓调节蛋白(Tm)联合检测对维持性血液透析(MHD)患者并发心血管疾病(CVD)的预测价值。方法 97例透析龄≥3个月的MHD患者,根据随访期间是否发生CVD将其分为CVD组(n=45)和非CVD组(n=52),并于同期随机选取40例体检健康者为对照组。采用劲动脉彩超检测中膜厚度(c IMT),酶联免疫吸附法检测血浆血栓调节蛋白(Tm),以多元Logistic回归分析MHD患者发生CVD的危险因素,受试者工作曲线(ROC)下面积(AUC)评估c IMT、Tm对CVD的预测价值。结果 CVD组c IMT值、血浆Tm水平均高于对照组(P均<0. 05)。BUN、c IMT、Tm是MHD患者发生CVD的独立危险因素(OR分别为1. 449、1. 791、1. 642,P均<0. 05)。c IMT预测MHD患者发生CVD的AUC为0. 869,最佳截断值为1. 73 mm,此时灵敏度、特异度分别为0. 86、0. 77,准确度为0. 82; Tm预测MHD患者发生CVD的AUC为0. 818,最佳截断值为19. 36 mg/L,此时灵敏度、特异度分别为0. 82、0. 71,准确度为0. 76; c IMT联合Tm预测MHD患者发生CVD的AUC为0. 956,灵敏度、特异度分别为0. 93、0. 85,准确度为0. 87。结论 c IMT增厚、血浆Tm水平升高是MHD患者并发CVD的高危因素,二者早期联合检测对预测MHD患者发生CVD的价值较高。
Objective To investigate the predictive value of combined detection of carotid intima-media thickness( c IMT) and plasma thrombomodulin( Tm) for cardiovascular disease( CVD) in maintenance hemodialysis( MHD) patients.Methods Ninety-seven MHD patients with dialysis age≥3 months were divided into the CVD group( n = 45) and nonCVD group( n = 52) according to whether CVD occurred during the follow-up period,and 40 healthy persons were randomly selected as the control group at the same time. The c IMT was examined by carotid ultrasonography,Tm was examined by enzyme linked immunosorbent assay,and Multivariate logistic regression was used to analyze the risk factors of CVD in MHD patients. AUC under ROC was used to evaluate the predictive value of c IMT and Tm for CVD. Results The levels of c IMT and plasma Tm in the CVD group was higher than those in the control group( both P < 0. 05). BUN,c IMT,and Tm were independent risk factors for CVD in the MHD patients( OR = 1. 449,1. 791,and 1. 642,respectively; all P <0. 05). The AUC of c IMT in predicting CVD of the MHD patients was 0. 869 and the best truncation value was 1. 73 mm;the sensitivity and specificity were 0. 86 and 0. 77,respectively,and the accuracy was 0. 82. The AUC of Tm in predicting CVD of the MHD patients was 0. 818 and the best truncation value was 19. 36 mg/L; the sensitivity and specificity were0. 82 and 0. 71,respectively,and the accuracy was 0. 76. The AUC of c IMT combined with Tm in predicting CVD of the MHD patients was 0. 956,with the sensitivity and specificity of 0. 93 and 0. 85,and the accuracy of 0. 87,respectively.Conclusion The increased c IMT and increased plasma Tm are high risk factors for CVD in MHD patients,and the early combined detection of them is of high value in predicting CVD for MHD patients.
Objective To investigate the predictive value of combined detection of carotid intima-media thickness( c IMT) and plasma thrombomodulin( Tm) for cardiovascular disease( CVD) in maintenance hemodialysis( MHD) patients.Methods Ninety-seven MHD patients with dialysis age≥3 months were divided into the CVD group( n = 45) and nonCVD group( n = 52) according to whether CVD occurred during the follow-up period,and 40 healthy persons were randomly selected as the control group at the same time. The c IMT was examined by carotid ultrasonography,Tm was examined by enzyme linked immunosorbent assay,and Multivariate logistic regression was used to analyze the risk factors of CVD in MHD patients. AUC under ROC was used to evaluate the predictive value of c IMT and Tm for CVD. Results The levels of c IMT and plasma Tm in the CVD group was higher than those in the control group( both P < 0. 05). BUN,c IMT,and Tm were independent risk factors for CVD in the MHD patients( OR = 1. 449,1. 791,and 1. 642,respectively; all P <0. 05). The AUC of c IMT in predicting CVD of the MHD patients was 0. 869 and the best truncation value was 1. 73 mm;the sensitivity and specificity were 0. 86 and 0. 77,respectively,and the accuracy was 0. 82. The AUC of Tm in predicting CVD of the MHD patients was 0. 818 and the best truncation value was 19. 36 mg/L; the sensitivity and specificity were0. 82 and 0. 71,respectively,and the accuracy was 0. 76. The AUC of c IMT combined with Tm in predicting CVD of the MHD patients was 0. 956,with the sensitivity and specificity of 0. 93 and 0. 85,and the accuracy of 0. 87,respectively.Conclusion The increased c IMT and increased plasma Tm are high risk factors for CVD in MHD patients,and the early combined detection of them is of high value in predicting CVD for MHD patients.
引文
[1] Huang JC,Tsai YC,Wu PY,et al. Independent association of overhydration with all-cause and cardiovascular mortality adjusted for gobal left ventricular longitudinal systolic strain and E/E'ratio in maintenance hemodialysis patients[J]. Kidney Blood Press Res,2018,43(4):1322-1332.
[2]Ren H,Sun R,Wang J. Relationship of melatonin level,oxidative stress and inflammatory status with osteoporosis in maintenance hemodialysis of chronic renal failure[J]. Exp Ther Med,2018,15(6):5183-5188.
[3] Centers for disease control and prevention(CDC). Atatespecific trends in chronic kidney failure,United States,1990-2001[J].Morb Mortal Wkly Rep,2004,53:918-920.
[4]Al-Shorman A,Al-Domi H,Al-Atoum M. The associations of body composition and anthropometric measures with carotid intima-media thickness in obese and non-obese schoolchildren:A possible predictor for cardiovascular diseases[J]. Vascular,2018,26(3):285-290.
[5]Chao TH,Tsai WC,Chen JY,et al. Soluble thrombomodulin is a paracrine anti-apoptotic factor for vascular endothelial protection[J]. Int J Cardiol,2014,172(2):340-349.
[6]Jespersen L,Hvelplund A,Abildstrom SZ,et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events[J].Eur Heart J,2012,33(6):734-744.
[7]Landmesser U,Hornig B,Drexler H. Endothelial function:a critical determinant in atherosclerosis[J]. Circulation,2004,109(21Suppl 1):Ⅱ27-Ⅱ33.
[8]赵俊丽,朱君君,邵霞,等.血液透析患者颈动脉内中膜厚度与血栓调节蛋白、炎症因子及心血管疾病的关联[J].肾脏病与透析肾移植杂志,2018,27(1):24-28.
[9]Siasos G,Sara JD,Zaromytidou M,et al. Local low shear stress and endothelial dysfunction in patients with nonobstructive coronary atherosclerosis[J]. J Am Coll Cardiol,2018,71(19):2092-2102.
[10]Gaubert M,Marlinge M,Alessandrini M,et al. Uric acid levels are associated with endothelial dysfunction and severity of coronary atherosclerosis during a first episode of acute coronary syndrome[J]. Purinergic Signal,2018,14(2):191-199.
[11]Wan Q,Liu Z,Yang Y,et al. Suppressive effects of berberine on atherosclerosis via downregulating visfatin expression and attenuating visfatin-induced endothelial dysfunction[J]. Int J Mol Med,2018,41(4):1939-1948.
[12] Alissa EM,Helmi SR,Al-Salmi MM. Relationship between diet quality and carotid intima-media thickness in people with and without carotid atherosclerosis[J]. J Family Med Prim Care,2018,7(3):531-537.
[13]许先进,董迅.颈动脉内膜中膜厚度的临床研究进展[J].中国动脉硬化杂志,2008,16(8):665-668.
[14]Nakanishi K,Masuda K,Mori N,et al. Evaluation of Analytical Performance of HISCL TM,a Chemiluminescent Enzyme Immunoassay and the Use of Thrombomodulin as a Marker for Endothelial Dysfunction[J]. Rinsho Byori,2014,62(10):942-947.
[15]许武红,邹原方,梁翔.血栓调节蛋白升高是维持性血液透析患者心血管疾病的危险因素[J].中国血液净化2015,14(4):224-226.
[16]Lin LC,Lee JD,Hung YC,et al. Bun/creatinine ratio-based hydration for preventing stroke-in-evolution after acute ischemic stroke[J]. Am J Emerg Med,2014,32(7):709-712.
[17] Goldberg RB. Cytokine and cytokine-like inflammation markers,endothelial dysfunction,and imbalanced coagulation in development of diabetes and its complications[J]. J Clin Endocrinol Metab,2009,94(9):3171-3182.
[2]Ren H,Sun R,Wang J. Relationship of melatonin level,oxidative stress and inflammatory status with osteoporosis in maintenance hemodialysis of chronic renal failure[J]. Exp Ther Med,2018,15(6):5183-5188.
[3] Centers for disease control and prevention(CDC). Atatespecific trends in chronic kidney failure,United States,1990-2001[J].Morb Mortal Wkly Rep,2004,53:918-920.
[4]Al-Shorman A,Al-Domi H,Al-Atoum M. The associations of body composition and anthropometric measures with carotid intima-media thickness in obese and non-obese schoolchildren:A possible predictor for cardiovascular diseases[J]. Vascular,2018,26(3):285-290.
[5]Chao TH,Tsai WC,Chen JY,et al. Soluble thrombomodulin is a paracrine anti-apoptotic factor for vascular endothelial protection[J]. Int J Cardiol,2014,172(2):340-349.
[6]Jespersen L,Hvelplund A,Abildstrom SZ,et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events[J].Eur Heart J,2012,33(6):734-744.
[7]Landmesser U,Hornig B,Drexler H. Endothelial function:a critical determinant in atherosclerosis[J]. Circulation,2004,109(21Suppl 1):Ⅱ27-Ⅱ33.
[8]赵俊丽,朱君君,邵霞,等.血液透析患者颈动脉内中膜厚度与血栓调节蛋白、炎症因子及心血管疾病的关联[J].肾脏病与透析肾移植杂志,2018,27(1):24-28.
[9]Siasos G,Sara JD,Zaromytidou M,et al. Local low shear stress and endothelial dysfunction in patients with nonobstructive coronary atherosclerosis[J]. J Am Coll Cardiol,2018,71(19):2092-2102.
[10]Gaubert M,Marlinge M,Alessandrini M,et al. Uric acid levels are associated with endothelial dysfunction and severity of coronary atherosclerosis during a first episode of acute coronary syndrome[J]. Purinergic Signal,2018,14(2):191-199.
[11]Wan Q,Liu Z,Yang Y,et al. Suppressive effects of berberine on atherosclerosis via downregulating visfatin expression and attenuating visfatin-induced endothelial dysfunction[J]. Int J Mol Med,2018,41(4):1939-1948.
[12] Alissa EM,Helmi SR,Al-Salmi MM. Relationship between diet quality and carotid intima-media thickness in people with and without carotid atherosclerosis[J]. J Family Med Prim Care,2018,7(3):531-537.
[13]许先进,董迅.颈动脉内膜中膜厚度的临床研究进展[J].中国动脉硬化杂志,2008,16(8):665-668.
[14]Nakanishi K,Masuda K,Mori N,et al. Evaluation of Analytical Performance of HISCL TM,a Chemiluminescent Enzyme Immunoassay and the Use of Thrombomodulin as a Marker for Endothelial Dysfunction[J]. Rinsho Byori,2014,62(10):942-947.
[15]许武红,邹原方,梁翔.血栓调节蛋白升高是维持性血液透析患者心血管疾病的危险因素[J].中国血液净化2015,14(4):224-226.
[16]Lin LC,Lee JD,Hung YC,et al. Bun/creatinine ratio-based hydration for preventing stroke-in-evolution after acute ischemic stroke[J]. Am J Emerg Med,2014,32(7):709-712.
[17] Goldberg RB. Cytokine and cytokine-like inflammation markers,endothelial dysfunction,and imbalanced coagulation in development of diabetes and its complications[J]. J Clin Endocrinol Metab,2009,94(9):3171-3182.