aCL和PAPP-A联合检测预测维持性血液透析患者发生心脑血管事件及死亡的价值

Prediction value of combined determination of a CL and PAPP-A for cardiovascular events and mortality in maintenance hemodialysis patients

目的探讨抗心磷脂抗体(a CL)和妊娠相关性血浆蛋白-A(PAPP-A)联合检测预测维持性血液透析(MHD)患者心脑血管事件及死亡的价值。方法检测126例行MHD患者的a CL和PAPP-A,记录随访期间患者心脑血管事件发生及死亡情况,分析a CL和PAPP-A检测结果与心脑血管事件及死亡的关系。结果 126例MHD患者中,血清a CL阳性43例(34.12%),血清PAPP-A阳性28例(22.22%),两者均阳性16例(12.69%),两者均阴性7例,a CL阳性PAPP-A阴性27例,a CL阴性PAPP-A阳性12例。随访(21.08±15.67)个月,随访期间发生心脑血管事件52例(41.26%),死亡23例(18.25%)。血清a CL阳性者和PAPP-A阳性者心脑血管事件发生率和病死率均高于a CL阴性者和PAPP-A阴性者(P均<0.05)。两者均阳性者心脑血管事件发生率和病死率显著高于两者均阴性及两者其一阳性者(P均<0.05)。生存分析显示两者单独阳性和联合阳性都对患者的生存有显著影响(P均<0.05)。结论血清a CL及PAPPA可能成为判断MHD患者发生心脑血管事件及生存预后的重要联合检测指标。

Objective It is to investigate the prediction value of combined determination of anti -cardiolipin antibodies （ aCL） and pregnancy associated plasma protein-A （ PAPP-A） of cardiovascular events and mortality in maintenance hemo-dialysis （ MHD） patients .Methods Serum aCL and PAPP -A in 126 enrolled MHD patients were measured in this study . The cardiovascular events and mortality were recorded during the period of observation followed -up, and the relationship be-tween the determination results and the events and death were analyzed .Results 43 （34.12%） of 126 patients were recorded with positive aCL level , 28 cases （22.22%） with positive PAPP-A and 16 cases（12.69%） with positive aCL and PAPP-A, 7 cases with negative aCL and PAPP -A, 27 cases with positive aCL and negative PAPP -A, 12 cases with negative aCL and positive PAPP-A.The following up time was （21.08 ＆#177;15.67）months, and during the following up stage, there were 52 cases of cardiovascular events and 23 cases of mortality .The incidences of cardiovascular events and mortality were higher in patients with positive aCL than those with negative levels （P＆lt;0.05）.Similar results were observed in patients with positive PAPP-A compared to those with negative level .Moreover, patients with positive aCL and positive PAPP -A had higher risk of cardiovascular events and mortality than those with negative levels （P＆lt;0.05）.Kaplan-Meier survival analysis showed a significant difference between patients with normal and abnormal aCL and PAPP -A levels .Conclusion The detections of aCL and PAPP-A in the serum of MHD patients may be the powerful predictive indicators of cardiovascular events and death .