維持性血液透析患者的血漿可溶性尿激酶型纖溶酶原激活物受體與冠脈鈣化、心血管事件及死亡的相關(guān)性研究
發(fā)布時(shí)間：2018-07-16 23:29
【摘要】：研究背景近年來我國(guó)透析患者數(shù)量以每年11%的速度遞增,維持性血液透析(maintain hemodialysis,MHD)成為主要的腎臟替代治療方式,然而血液透析患者的病死率比年齡匹配的普通人群高10-20倍,其中心血管事件造成的死亡占總死亡原因的50%以上,而冠狀動(dòng)脈鈣化是造成透析患者心血管疾病高發(fā)病率和高病死率的重要因素。因此對(duì)于血透患者心血管事件早期預(yù)測(cè)有著重要的臨床意義。可溶性尿激酶型纖溶酶原激活物受體(solubleurokinase-type plasminogen activator receptor,suPAR)作為一種新型的炎癥標(biāo)志物,在吸煙、糖尿病、慢性腎臟疾病體內(nèi)呈高表達(dá),且能增加心腦血管疾病發(fā)生。此外,有報(bào)道顯示suPAR能預(yù)測(cè)普通人群心血管疾病發(fā)生及與血管鈣化有關(guān)。但是,MHD患者suPAR是否與血管鈣化及心血管疾病有關(guān)尚無文獻(xiàn)報(bào)道。因此,本研究旨在探討MHD患者血漿suPAR與血管鈣化、心血管事件(CVD)之間的關(guān)系,了解其在MHD患者中的價(jià)值,為其臨床應(yīng)用提供理論依據(jù)。目的探討維持性血液透析(MHD)患者的血漿可溶性尿激酶型纖溶酶原激活物受體(suPAR)與冠脈鈣化、心血管事件(CVD)及死亡的關(guān)系方法2010年1月1日-2015年6月1日,納入在廣東省人民醫(yī)院血液透析中心進(jìn)行維持性血液透析治療的99名成人患者進(jìn)行研究。收集其基線資料,包括一般情況,既往心血管疾病病史,生化指標(biāo):血紅蛋白(Hb)、血清鈣、血清磷、白蛋白(Alb)、堿性磷酸酶(Alp)、高敏C反應(yīng)蛋白(hs-CRP)、全段甲狀旁腺激素(iPTH)等。用ELISA方法檢測(cè)其血漿suPAR,用64層螺旋CT(MSCT)測(cè)定冠狀動(dòng)脈鈣化積分(CACS),隨訪至2016年6月1日,統(tǒng)計(jì)發(fā)生心血管事件或死亡的患者,分析suPAR與CACS的關(guān)系,及suPAR對(duì)心血管事件發(fā)生率和全因死亡的影響。結(jié)果.隨訪截止至2016年6月1日,中位觀察33(22,58)月。91例患者(91.9%)存在不同程度的血管鈣化,Spearman相關(guān)分析中,suPAR與冠狀動(dòng)脈鈣化程度呈正相關(guān)(P=0.001,r=0.315),與CACS100分組比較,CACS≥100分組血漿suPAR顯著提高,兩組之間差別有統(tǒng)計(jì)學(xué)意義(P=0.048)。根據(jù)血漿suPAR的四分位數(shù)進(jìn)行分析,發(fā)現(xiàn)高suPAR組心血管事件和全因死亡率最高P0.05)。單因素Cox回歸分析中,suPAR是心血管事件和全因死亡的危險(xiǎn)因素,HR=2.573(1.708-3.876),P=0.025;2.806(1.139-6.195),P=0.025;多因素 COX 回歸模型顯示suPAR仍然是心血管事件發(fā)生的獨(dú)立危險(xiǎn)因素,HR=2.960(1.638～5.355),p0.001。結(jié)論在維持性血透患者中,suPAR與冠狀動(dòng)脈鈣化程度呈正相關(guān),suPAR作為心血管事件發(fā)生的獨(dú)立危險(xiǎn)因素,對(duì)維持性血透患者心血管事件的發(fā)生有一定的預(yù)測(cè)作用。
[Abstract]:Background in recent years, the number of hemodialysis patients in China has been increasing at an annual rate of 11%. Maintenance hemodialysis (maintain) has become the main form of renal replacement therapy. However, the mortality of hemodialysis patients is 10-20 times higher than that of the age-matched general population. More than 50% of the causes of death were caused by cardiovascular events, and coronary artery calcification was an important factor in the high incidence and mortality of cardiovascular disease in dialysis patients. Therefore, early prediction of cardiovascular events in hemodialysis patients has important clinical significance. Soluble urokinase type plasminogen activator receptor (solubleurokinase-type plasminogen activator receptor suPAR), as a new inflammatory marker, is highly expressed in smoking, diabetes, chronic renal diseases and can increase the occurrence of cardiovascular and cerebrovascular diseases. In addition, it has been reported that suPAR can predict cardiovascular disease and vascular calcification in the general population. However, whether suPAR in MHD patients is associated with vascular calcification and cardiovascular disease has not been reported. Therefore, the purpose of this study was to explore the relationship between plasma suPAR and vascular calcification and cardiovascular events (CVD) in MHD patients, to understand its value in MHD patients, and to provide theoretical basis for its clinical application. Objective to investigate the relationship between plasma soluble urokinase-type plasminogen activator receptor (suPAR) and coronary artery calcification, cardiovascular events (CVD) and death in patients with maintenance hemodialysis (MHD). A study of 99 adult patients undergoing maintenance hemodialysis at the Hemodialysis Center of Guangdong Provincial people's Hospital was conducted. The baseline data were collected, including general information, past history of cardiovascular disease, biochemical indexes: hemoglobin (HB), serum calcium, serum phosphorus, albumin (Alb), alkaline phosphatase (Alp), Gao Min C-reactive protein (hs-CRP), total parathyroid hormone (iPTH) and so on. Plasma suPAR was measured by Elisa, coronary artery calcification score (CACS) was measured by 64-slice spiral CT (MSCT), followed up until June 1, 2016. The relationship between suPAR and CACS was analyzed. And suPAR on the incidence of cardiovascular events and all-cause death. Result As of June 1, 2016, a median of 91 (91.9%) patients (91.9%) with different degrees of vascular calcification was observed as of June 1, 2016. In Spearman correlation analysis, suPAR was positively correlated with coronary artery calcification (P < 0. 001). Compared with CACS 100, plasma suPAR was significantly increased in CACS 鈮，
本文編號(hào)：2128039
[Abstract]:Background in recent years, the number of hemodialysis patients in China has been increasing at an annual rate of 11%. Maintenance hemodialysis (maintain) has become the main form of renal replacement therapy. However, the mortality of hemodialysis patients is 10-20 times higher than that of the age-matched general population. More than 50% of the causes of death were caused by cardiovascular events, and coronary artery calcification was an important factor in the high incidence and mortality of cardiovascular disease in dialysis patients. Therefore, early prediction of cardiovascular events in hemodialysis patients has important clinical significance. Soluble urokinase type plasminogen activator receptor (solubleurokinase-type plasminogen activator receptor suPAR), as a new inflammatory marker, is highly expressed in smoking, diabetes, chronic renal diseases and can increase the occurrence of cardiovascular and cerebrovascular diseases. In addition, it has been reported that suPAR can predict cardiovascular disease and vascular calcification in the general population. However, whether suPAR in MHD patients is associated with vascular calcification and cardiovascular disease has not been reported. Therefore, the purpose of this study was to explore the relationship between plasma suPAR and vascular calcification and cardiovascular events (CVD) in MHD patients, to understand its value in MHD patients, and to provide theoretical basis for its clinical application. Objective to investigate the relationship between plasma soluble urokinase-type plasminogen activator receptor (suPAR) and coronary artery calcification, cardiovascular events (CVD) and death in patients with maintenance hemodialysis (MHD). A study of 99 adult patients undergoing maintenance hemodialysis at the Hemodialysis Center of Guangdong Provincial people's Hospital was conducted. The baseline data were collected, including general information, past history of cardiovascular disease, biochemical indexes: hemoglobin (HB), serum calcium, serum phosphorus, albumin (Alb), alkaline phosphatase (Alp), Gao Min C-reactive protein (hs-CRP), total parathyroid hormone (iPTH) and so on. Plasma suPAR was measured by Elisa, coronary artery calcification score (CACS) was measured by 64-slice spiral CT (MSCT), followed up until June 1, 2016. The relationship between suPAR and CACS was analyzed. And suPAR on the incidence of cardiovascular events and all-cause death. Result As of June 1, 2016, a median of 91 (91.9%) patients (91.9%) with different degrees of vascular calcification was observed as of June 1, 2016. In Spearman correlation analysis, suPAR was positively correlated with coronary artery calcification (P < 0. 001). Compared with CACS 100, plasma suPAR was significantly increased in CACS 鈮，
本文編號(hào)：2128039
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