[1]苏玉萍,王燕梅.维持性血液透析患者血液Lp(a)，Fib水平检测与自体动静脉内瘘血管钙化及严重程度的关系[J].现代检验医学杂志,2024,39(06):141-146+166.[doi:10.3969/j.issn.1671-7414.2024.06.024]
　SU Yuping,WANG Yanmei.Relationship between Lp (a), Fib Levels and Vascular Calcification and Severity of Autogenous Arteriovenous Fistula in Maintenance Hemodialysis Patients[J].Journal of Modern Laboratory Medicine,2024,39(06):141-146+166.[doi:10.3969/j.issn.1671-7414.2024.06.024]
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维持性血液透析患者血液Lp(a)，Fib水平检测与自体动静脉内瘘血管钙化及严重程度的关系()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年06期
页码:
141-146+166
栏目:
论著
出版日期:
2024-11-15

文章信息/Info

Title:
Relationship between Lp (a), Fib Levels and Vascular Calcification and Severity of Autogenous Arteriovenous Fistula in Maintenance Hemodialysis Patients
文章编号:
1671-7414（2024）06-141-07
作者:
苏玉萍; 王燕梅
（遂宁市中心医院肾内科，四川遂宁 629000）
Author(s):
SU Yuping; WANG Yanmei
（Department of Nephrology, Suining Central Hospital, Sichuan Suining 629000, China）
关键词:
脂蛋白; 纤维蛋白原; 维持性血液透析; 动静脉内瘘; 血管钙化
分类号:
R459.5 ；R446.11
DOI:
10.3969/j.issn.1671-7414.2024.06.024
文献标志码:
A
摘要:
目的 探讨维持性血液透析（maintenance hemodialysis，MHD）患者血液脂蛋白[lipoprotein(a)，Lp(a)]、纤维蛋白原（fibrinogen Fib）水平检测与自体动静脉内瘘（autogenous arteriovenous fistula，AVF）血管钙化及严重程度的关系。方法 选择2021 年11 月~2023 年11 月于遂宁市中心医院就诊的112 例MHD 患者作为研究对象。根据其AVF 血管钙化程度将所有患者分为无钙化组（n=45）和钙化组（n=67），其中钙化组分为轻度钙化组（n=19）、中度钙化组（n=28）和重度钙化组（20 例）。比较无钙化组和钙化组患者的一般资料及Lp(a) 和Fib 水平。采用多因素Logistic 回归模型确定MHD 患者AVF 血管钙化的独立风险预测因子。比较不同钙化程度患者临床资料。采用广义混合效应模型分析Lp(a) 和Fib 水平与MHD 患者AVF 血管钙化程度的关系。采用限制性立方样条模型分析Lp(a) 和Fib 与AVF 血管重度钙化的剂量反应关系。分析Lp(a) 和Fib 对AVF 血管钙化严重程度的交互作用。结果 钙化组患者透析时间、血磷(P)、甲状旁腺素（PTH）、血清肌酐（Scr）、血红蛋白（Hb）、骨形态发生蛋白-2（BMP-2）、成纤维细胞生长因子21（FGF-21）、Lp(a) 和Fib 水平明显升高（t=17.420，9.644，4.863，6.646，2.158，12.046，13.290，2.395，6.674，均P<0.05），Ca 水平则明显降低（t=2.820，P=0.006），差异具有统计学意义。多因素分析结果显示，透析时间（OR：3.130，95%CI：1.652~5.931），P（OR：4.760，95%CI：2.103~7.133），PTH（OR：3.314，95%CI：1.062~6.045），Scr（OR：2.288，95%CI：1.168~4.481），Hb（OR：4.616，95%CI：2.384~7.949），BMP-2（OR：5.527，95%CI：2.598~9.212），FGF-21（OR：6.242，95%CI：1.201~11.184），Lp(a)（OR：5.509，95%CI：2.787~10.886）和Fib（OR：6.159，95%CI：2.125~12.140）均为影响MHD 患者AVF 血管钙化的独立危险因素（均P<0.05）。轻度、中度及重度钙化组在透析时间、Ca，PTH，Scr，Hb，BMP-2，FGF-21，La（a）和Fib 水平差异有统计学意义（F=2.028~6.324，均P<0.05），重度钙化组患者透析时间，PTH，Scr，Hb，BMP-2，FGF-21，Lp(a) 和Fib 水平高于轻度钙化组（t=2.204~11.064）和中度钙化组（t=2.025~3.197），Ca 水平则明显降低（t=3.121，2.471），差异具有统计学意义（均P<0.05）。广义混合效应模型结果显示，Lp(a) 和Fib 水平与MHD 患者AVF 血管钙化程度有关。限制性立方样条模型结果显示，Lp(a)和Fib 水平与AVF 血管重度钙化的关联呈非线性的剂量反应关系。血清Lp(a) 和Fib 水平对AVF 血管钙化严重程度的影响存在交互作用（OR=6.324，2.534，均P<0.05）。结论 Lp(a) 和Fib 与患者血管钙化程度具有一定相关性，可能是MHD 患者自体AVF 血管钙化的影响因素。
Abstract:
Objective To explore the relationship between lipoprotein (a) [Lp (a)], fibrinogen (Fib) levels and vascular calcification and severity of autogenous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients. Methods A total of 112 MHD patients who visited Suining Central Hospital from November 2021 to November 2023 were selected as the study subjects. According to the degree of AVF vascular calcification, these patients were divided into a non calcified group (n=45) and a calcified group (n=67), in which the calcified group was divided into a mild calcification group (n=19), a moderate calcification group (n=28) and a severe calcification group (n=20). The general information and Lp (a) and Fib levels between non calcified group and calcified group were compared. Multivariate logistic regression model was used to determine the independent risk predictors of AVF vascular calcification in MHD patients. Clinical data of patients with different degrees of calcification were compared. Generalized mixed effects model was used to analyze the relationship between Lp (a), Fib levels and the degree of AVF vascular calcification in MHD patients. Restricted cubic spline model was used to analyze the doseresponse relationship between Lp (a) and Fib and severe vascular calcification in AVF. The interaction between Lp (a) and Fib on the severity of vascular calcification in AVF was analyzed. Results Dialysis time, P, PTH, Scr, Hb, BMP-2, FGF-21, Lp (a) and Fib levels of patients in the calcification group were increased (t=17.420, 9.640, 4.863, 6.646, 2.158, 12.046, 13.290, 2.395, 6.674, all P<0.05), while Ca level was decreased (t=2.820, P=0.006), the differences were statistically significant, respectively. The results of multivariate analysis showed that dialysis time(OR: 3.130, 95%CI: 1.652~5.931), P(OR: 4.760, 95%CI: 2.103~7.133), PTH(OR: 3.314, 95%CI: 1.062~6.045), Scr(OR: 2.288, 95%CI: 1.168~4.481), Hb(OR: 4.616, 95%CI: 2.384~7.949), BMP-2(OR: 5.527, 95%CI: 2.598~9.212), FGF-21(OR: 6.242, 95%CI: 1.201~11.184), Lp(a)(OR: 5.509, 95%CI: 2.787~10.886) and Fib(OR: 6.159, 95%CI: 2.125~12.140) were all independent risk factors for AVF vascular calcification in MHD patients (all P<0.05). There were statistically significant in dialysis time, Ca, PTH, Scr, Hb, BMP-2, FGF-21, Lp(a) and Fib levels among the three groups(F=2.028~6.324, all P<0.05). Patients in the severe calcification group had higher dialysis time, PTH, Scr, Hb, BMP-2, FGF-21, Lp (a) and Fib levels than those in the mild calcification group(t=2.204~11.064) and the moderate calcification group(t=2.025~3.197), while Ca level was reduced(t=3.121, 2.471), with statisitcally significant differences ( all P<0.05), respectively. The results of the generalized mixed effects model showed that the levels of Lp (a) and Fib were related to the degree of AVF vascular calcification in MHD patients. The results of the restricted cubic spline model showed a non-linear dose-response relationship between Lp (a) and Fib levels and severe vascular calcification in AVF. There was an interactive effect between serum Lp (a) and Fib levels on the severity vascular calcification in AVF (OR=6.324, 2.534, all P<0.05). Conclusion Lp (a) and Fib have a certain correlation with the degree of vascular calcification in patients, which may be influencing factors of autogenous AVF vascular calcification in MHD patients.

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备注/Memo

备注/Memo:
作者简介： 苏玉萍（1994-），女，硕士研究生，住院医师，研究方向：肾脏病学，E-mail:yuping761@163cn.com.cn。
通讯作者：王燕梅，住院医师。
更新日期/Last Update: 2024-11-15