慢性肾脏病患者血清肿瘤坏死因子样弱凋亡诱导因子与疾病进展的相关性分析

Correlation between Serum Tumor Necrosis Factor-like Weak Inducer of Apoptosis and Disease Progression in Patients with Chronic Kidney Disease

目的探讨慢性肾脏病(chronic kidney disease,CKD)患者血清肿瘤坏死因子样弱凋亡诱导因子(tumor necrosis factor-like weak apoptosis inducing factor,TWEAK)水平与疾病进展的相关性。方法选取2014年1月至2016年1月厦门大学附属第一医院收治的100例CKD患者纳入观察组,另选取同期在该医院体检的健康居民100例作为对照组,采用酶联免疫吸附法分别检测2组的血清TWEAK水平,随访2年,分析血清TWEAK水平与CKD进展的相关性。结果观察组患者血清TWEAK水平为(313.59±54.37)pg/mL,显著低于对照组的(387.62±88.32)pg/mL,差异有统计学意义(P<0.01);随着CKD进展,1期~5期患者血清TWEAK水平逐期降低;Pearson相关性分析结果显示,CKD患者血清TWEAK水平与血清肌酐、血清尿素氮及尿酸呈负相关(均P<0.01),与肾小球滤过率呈正相关(P<0.01),与24 h尿蛋白定量无相关性(P>0.05);多因素Logistic回归分析显示,年龄、高血压、糖尿病、血清尿酸及血清TWEAK是慢性肾脏病病情进展的危险因素(均P<0.05);在2年随访期内,100例CKD患者中有25例(25%)达到终点事件,将达到终点事件的患者按血清TWEAK水平平均值分为2组,其中A组(≥227.62 pg/mL)4例和B组(<227.62 pg/mL)21例,将血清TWEAK水平作为变量,经COX单变量分析显示,A组达到终点事件的风险显著低于B组(P<0.05)。结论 TWEAK在CKD患者血清中低表达,其水平与CKD分期及预后密切相关。

Objective To investigate the relationship between serum tumor necrosis factor-like weak inducer of apoptosis(TWEAK) and disease progression in patients with chronic kidney disease(CKD).Methods From January 2014 to January 2016,100 patients with CKD who were admitted to our hospital were selected and included in the observation group.In the same period,100 healthy residents who underwent physical examination in our hospital were included in the control group.The serum TWEAK was detected by enzyme-linked immunosorbent assay.The patients were followed up for 2 years.Serum TWEAK was analyzed.The correlation between the level and progression of CKD was studied.Results The serum TWEAK level in the observation group was(313.59±54.37)pg/mL,which was significantly lower in the control group(387.62±88.32)pg/mL.There was a statistically significant difference(P<0.01).With the progression of CKD,serum TWEAK levels gradually decreased in patients from stage 1 to stage 5.Pearson correlation analysis showed that serum TWEAK levels were negatively correlation with serum creatinine,serum urea nitrogen and serum uric acid in patients with CKD(P<0.01),positively correlated with glomerular filtration rate(P<0.05),and had no correlation with 24-h urinary protein quantification(P>0.05).Multivariate logistic regression analysis showed that age,hypertension,diabetes,serum uric acid and serum TWEAK were risk factors for progression of chronic kidney disease(P<0.05).During the 2-year follow-up period,25(25%) of the 100 patients with chronic kidney disease reached the endpoint,and the patients who achieved the endpoint were divided into 2 groups according to the mean value of serum TWEAK:group A(≥227.62 pg/mL,n=4),group B(<227.62 pg/mL,n=21).Serum TWEAK levels were taken as variables.According to COX univariate analysis,the risk of endpoint event was significantly lower in group A than in group B(P<0.05).Conclusion TWEAK is lowly expressed in the serum of patients with CKD,and its expression level is closely related to the severity of the patient’s condition and prognosis.