血清血管性血友病因子裂解酶与慢性肾衰竭MHD患者血管钙化的相关性

Correlation analysis between serum ADAMTS13 and vascular calcification in patients with chronic renal failure and maintenance hemodialysis

目的探讨血清血管性血友病因子裂解酶(ADAMTS13)水平与慢性肾衰竭(CRF)维持性血液透析(MHD)患者血管钙化的相关性。方法选取2018年10月至2020年6月在本院就诊的行MHD治疗的105例CRF患者为研究对象。依据是否出现血管钙化分为血管钙化组(68例)和无血管钙化组(37例)。采用酶联免疫吸附(ELISA)法检测患者血清AD-AMTS13水平,绘制受试者工作特征(R0C)曲线确定ADAMTS13的预测价值,应用logistic回归分析判断影响CRF并MHD患者血管钙化的相关因素结果血管钙化组的年龄、糖尿病史比例、血Ca水平、耗磷乘积、iPrH水平均明显高于无血管钙化组,ADAMTS13含量低于无血管钙化组(P<0.05);血清ADAMTS13与年龄、血Ca、钙磷乘积、iPTH呈负相关(r=-0.625、-0.743、-0.622、-0.668,P<0.05);血清ADAMTS13、sCa、iPTH、钙磷乘积在预测CRF并MHD患者发生血管钙化曲线下面积(AUC)分别为0.797(95%CI:0.733~0.855)、0.626(95%CI:0.573-0.687)、0.733(95%CI:0.601-0.822)、0.728(95%CI:0.672~0.793)。在278.6 ng/mL的临界值下,ADAMTS13预测的灵敏度为84.6%,特异度为80.1%;血Ca、iPTH、妈磷乘积预测的灵敏度分别为78.3%、75.2%、74.3%,特异度分別为65.2%、66.2%、65.7%。Logistic回归分析显示:高水平ADAMTS13是CRF并MHD患者出现血管钙化的保护因素(OR=0.243,95%CI:0.155~0.381,P<0.05),高水平血Ca、高水平iPTH、高钙磷乘积是CRF并MHD患者出现血管钙化的危险因素(OR=1.612、2.469、2.254,95%CI:1.035~2.511、1.822~3.346、1.799~2.824,P<0.05)。结论血清ADAMTS13在预测CRF并MHD患者发生血管钙化方面具有一定的临床应用价值,可以作为CRF合并MHD发生血管钙化的早期生物标志物。

Objective To investigate the correlation between serum ADAMTS13 and vascular calcification in patients with chronic renal failure and maintenance hemodialysis.Methods A total of 105 CRF patients who underwent MHD treatment in our hospital from October 2018 to June 2020 were selected as the research objects.According to whether vascular calrification occurred,they were divided into vascular calcification group(68 cases)and non avascular calcification group(37 cases).Enzyme-linked immunosorbent assay(ELISA)was used to detect serum ADAMTS13 levels,and receiver operating characteristic(HOC)curves were drawn to determine the predictive value of ADAMTS13.Logistic regression analysis was used to determine the relevant factors affecting vascular calcification in patients with chronic renal failure on maintenance hemodialysis.Results The age,diabetes history ratio,Serum Ca level,calc'iiini-phosphorus product,and iPTH level of vascular calcification group were significantly higher than those of the non-vascular calcification group,and the level of ADAMTS13 was lower than that of the non-vascular calcification group(P<0.05).Serum ADAMTS13 was correlated with age,Serum Ca,the product of calcium and phosphorus and iPTH were negatively correlated(r=-0.625,-0.743,-0.622,-0.668,P<0.05).The AUC of serum ADAMTS13,Serum Ca,iPTH,calcium and phosphorus product in predicting the VC in patients with CRF and MHD were 0.797,0.626,0.733,0.728.Under the critical value of 278.6 ng/mL,the predictive sensitivity of ADAMTS13 was 84.6%and the sperifirity 80.1%;the predictive sensitivity of Serum Ca,iPTH,and calcium-phosphorus product were 78.3%,75.2%,74.3%,and the specificity were 65.2%,66.2%,65.7%,respectively.Logistic regression analysis showed that high-level ADAMTS13 was a protective factor for vascular calcification in patients with CRF and MHD,and high-level Serum Ca,high-level iPTH,and high calcium-phosphorus product were risk factors for vascular calcification in patients with CRF and MHD.The OR and 95%CI were 0.243(0.155-0.381),1.612(1.035-2.511),2.469(1.822-3.346),2.254(1.799-2.824)respectively.Conclusions Serum AD-AMTS13 may have certain clinical application value in predicting the occurrence of vascular calcification in jjatients with CRF and MHD,and it can be used as an early biomarker for the occurrence of vascular calcification in CRF and MHD.