维持性血液透析患者的血浆可溶性尿激酶型纤溶酶原激活物受体与冠脉钙化、心血管事件及死亡的相关性研究
发布时间：2018-07-16 23:29
【摘要】：研究背景近年来我国透析患者数量以每年11%的速度递增,维持性血液透析(maintain hemodialysis,MHD)成为主要的肾脏替代治疗方式,然而血液透析患者的病死率比年龄匹配的普通人群高10-20倍,其中心血管事件造成的死亡占总死亡原因的50%以上,而冠状动脉钙化是造成透析患者心血管疾病高发病率和高病死率的重要因素。因此对于血透患者心血管事件早期预测有着重要的临床意义。可溶性尿激酶型纤溶酶原激活物受体(solubleurokinase-type plasminogen activator receptor,suPAR)作为一种新型的炎症标志物,在吸烟、糖尿病、慢性肾脏疾病体内呈高表达,且能增加心脑血管疾病发生。此外,有报道显示suPAR能预测普通人群心血管疾病发生及与血管钙化有关。但是,MHD患者suPAR是否与血管钙化及心血管疾病有关尚无文献报道。因此,本研究旨在探讨MHD患者血浆suPAR与血管钙化、心血管事件(CVD)之间的关系,了解其在MHD患者中的价值,为其临床应用提供理论依据。目的探讨维持性血液透析(MHD)患者的血浆可溶性尿激酶型纤溶酶原激活物受体(suPAR)与冠脉钙化、心血管事件(CVD)及死亡的关系方法2010年1月1日-2015年6月1日,纳入在广东省人民医院血液透析中心进行维持性血液透析治疗的99名成人患者进行研究。收集其基线资料,包括一般情况,既往心血管疾病病史,生化指标:血红蛋白(Hb)、血清钙、血清磷、白蛋白(Alb)、碱性磷酸酶(Alp)、高敏C反应蛋白(hs-CRP)、全段甲状旁腺激素(iPTH)等。用ELISA方法检测其血浆suPAR,用64层螺旋CT(MSCT)测定冠状动脉钙化积分(CACS),随访至2016年6月1日,统计发生心血管事件或死亡的患者,分析suPAR与CACS的关系,及suPAR对心血管事件发生率和全因死亡的影响。结果.随访截止至2016年6月1日,中位观察33(22,58)月。91例患者(91.9%)存在不同程度的血管钙化,Spearman相关分析中,suPAR与冠状动脉钙化程度呈正相关(P=0.001,r=0.315),与CACS100分组比较,CACS≥100分组血浆suPAR显著提高,两组之间差别有统计学意义(P=0.048)。根据血浆suPAR的四分位数进行分析,发现高suPAR组心血管事件和全因死亡率最高P0.05)。单因素Cox回归分析中,suPAR是心血管事件和全因死亡的危险因素,HR=2.573(1.708-3.876),P=0.025;2.806(1.139-6.195),P=0.025;多因素 COX 回归模型显示suPAR仍然是心血管事件发生的独立危险因素,HR=2.960(1.638～5.355),p0.001。结论在维持性血透患者中,suPAR与冠状动脉钙化程度呈正相关,suPAR作为心血管事件发生的独立危险因素,对维持性血透患者心血管事件的发生有一定的预测作用。
[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，
本文编号：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，
本文编号：2128039
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