维持性血液透析患者血清SDF-1、CXCR4表达与心血管并发症的关系研究

Study on the relationships between the expressions of serum SDF-1, CXCR4 and cardiovascular complications in maintenance hemodialysis patients

【目的】检测基质细胞衍生因子-1(SDF-1)、趋化因子受体4(CXCR4)在维持性血液透析(MHD)患者血清中表达情况,探讨SDF-1、CXCR4与MHD患者心血管并发症的相关性。【方法】选择2017年10月~2019年11月在本院血液净化中心治疗的MHD患者113例,其中无心血管疾病患者68例,并发心血管事件患者45例。另选同期健康体检人员100例作为对照组。采用酶联免疫吸附法检测各观察对象血清SDF-1、CXCR4水平,Pearson法分析相关分析MHD并发心血管疾病患者血清SDF-1、CXCR4与高敏C反应蛋白(hs-CRP)、氨基末端B型利钠肽原(NT-proBNP)、左心室射血分数(LVEF)相关性,Logistic回归分析检验影响MHD并发心血管疾病的因素,ROC曲线分析SDF-1、CXCR4表达对MHD患者心血管并发症的诊断价值。【结果】与对照组比较,MHD组患者血清SDF-1、CXCR4表达水平明显升高,差异有统计学意义(P<0.05);与无心血管疾病组比较,有心血管疾病组MHD患者肌钙蛋白TnI、肌酶、hs-CRP、肌酐(Cr)、胱抑素C(Cys-C)、同型半胱氨酸(Hcy)、NT-proBNP、SDF-1、CXCR4表达水平显著升高,LVEF降低,差异有统计学意义(P<0.05);相关性分析显示,MHD并发心血管疾病患者SDF-1、CXCR4表达水平与血清hs-CRP、NT-proBNP呈正相关(P<0.05),与LVEF呈负相关(P<0.05);SDF-1、CXCR4是影响MHD患者并发心血管疾病独立危险因素;血清SDF-1、CXCR4联合预测预测MHD患者心血管并发症敏感度为91.11%,特异度为82.35%,曲线下面积为0.913。【结论】SDF-1、CXCR4在MHD心血管并发症患者血清中高表达,可能作为预测MHD患者心血管并发症潜在的标志物。

【Objective】To detect the expressions of stromal cell-derived factor-1(SDF-1)and chemokine receptor-4(CXCR4)in the serum of patients with maintenance hemodialysis(MHD),and to explore the correlation between SDF-1,CXCR4 and cardiovascular complications in MHD.【Methods】From October 2017 to November 2019,113 MHD patients treated in our blood purification center were selected,including 68 patients without cardiovascular disease and 45 patients with cardiovascular events.Another 100 healthy persons in the same period were selected as the control group.The levels of serum SDF-1 and CXCR4 were detected by enzyme linked immunosorbent assay,Pearson method was used to analyze the correlation between serum SDF-1,CXCR4 and high sensitive C-reactive protein(hs-CRP),N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),Logistic regression analysis was used to examine the influencing factors of MHD complicated with cardiovascular disease,and ROC curve was used to analyze the value of SDF-1 and CXCR4 expressions in the diagnosis of cardiovascular complications in MHD patients.【Results】Compared with those in the control group,the expression levels of serum SDF-1 and CXCR4 in MHD group were significantly higher(P<0.05);compared with those in the non cardiovascular disease group,the expression levels of troponin TnI,muscle enzyme,hs-CRP,creatinine(Cr),Cystatin C(Cys-C),homocysteine(Hcy),NT-proBNP,SDF-1 and CXCR4 in MHD group with cardiovascular disease were significantly higher(P<0.05),LVEF was significantly lower(P<0.05);the correlation analysis showed that the expression level of SDF-1 and CXCR4 of MHD patients with cardiovascular disease was positively correlated with hs-CRP and NT-proBNP(P<0.05),and negatively correlated with LVEF(P<0.05);SDF-1 and CXCR4 were independent risk factors of cardiovascular disease in MHD patients;in addition,the sensitivity,specificity and area under the curve of serum SDF-1 combined with CXCR4 in predicting of cardiovascular complications in MHD patients were 91.11%,82.35%and 0.913 respectively.【Conclusion】SDF-1 and CXCR4 are highly expressed in the serum of MHD patients with cardiovascular complications,and may be a potential marker for predicting cardiovascular complications in MHD patients.