血浆ApoM预测尿毒症MHD患者下肢动脉病变的价值

Value of plasma ApoM in predicting lower extremity arterial lesions in patients with uremic MHD

目的研究尿毒症维持性血液透析(MHD)患者血浆载脂蛋白M(ApoM)对下肢动脉病变的预测价值。方法以河北工程大学附属医院2013-2016年收治的180例尿毒症MHD患者作为研究对象,随访观察3年,将随访期间发生下肢动脉病变的55例患者作为病变组,未发生下肢动脉病变的125例患者作为无病变组。比较两组一般资料以及各项实验室指标,采用多因素Logistic回归分析尿毒症MHD患者下肢动脉病变的影响因素,分析尿毒症MHD患者血浆ApoM水平与其他影响因素的相关性,采用受试者工作特征(ROC)曲线分析血浆ApoM对尿毒症MHD患者发生下肢动脉病变的预测价值。结果病变组年龄、合并高血压和糖尿病人数占比,以及总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)水平均高于无病变组(P<0.05),ApoM水平低于无病变组(P<0.05)。多因素Logistic回归分析显示,年龄、高血压、糖尿病、TC、TG、LDL-C、hs-CRP均是尿毒症MHD患者下肢动脉病变的独立危险因素(OR>1,P<0.05),而ApoM是尿毒症MHD患者下肢动脉病变的保护性因素(OR<1,P<0.05)。Pearson相关分析结果显示,尿毒症MHD患者血浆ApoM水平与TC、TG、LDL-C、hs-CRP均呈负相关(P<0.05)。ROC曲线分析结果显示,血浆ApoM预测尿毒症MHD患者下肢动脉病变的曲线下面积为0.933,灵敏度为0.912,特异度为0.847。结论血浆ApoM水平与TC、TG、LDL-C和hs-CRP呈负相关,是尿毒症MHD患者发生下肢动脉病变的保护性因素,临床上可辅助预测尿毒症MHD患者发生下肢动脉病变的风险。

Objective To study the predictive value of plasma apolipoprotein M(ApoM)in lower extremity arterial lesions in uremic maintenance hemodialysis(MHD)patients.Methods A total of 180 patients with uremic MHD admitted to the Affiliated Hospital of Hebei University of Engineering during 2013-2016 were taken as the research subjects,and conducted the follow-up and observation for 3 years.Fifty-five patients with lower extremity arterial lesions during the follow-up period were taken as the lesions group,125 patients without lower extremity arterial lesions served as the non-lesions group.The general data and various laboratory indicators were compared between the two groups.The multivariate Logistic regression was used to analyze the influencing factors of lower extremity arterial lesions in the patients with uremic MHD,and the correlation between plasma ApoM levels and other influencing factors in the patients with uremic MHD was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of plasma ApoM for lower extremity arterial lesions occurrence in the patients with uremic MHD.Results The age,the proportion of the patients with complicating hypertension and diabetes,and the levels of total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)and high sensitivity C-reactive protein(hs-CRP)in the lesions group were all higher than those in the non-lesions group(P<0.05),and the level of ApoM was lower than that in the non-lesions group(P<0.05).The multivariate Logistic regression analysis showed that age,hypertension,diabetes,TC,TG,LDL-C and hs-CRP all were the independent risk factors for lower extremity arterial lesions in the patients with uremic MHD(OR>1,P<0.05),while ApoM was a protective factor for lower extremity arterial lesions in the patients with uremic MHD(OR<1,P<0.05).The Pearson correlation analysis results showed that the level of plasma ApoM was negatively correlated with TC,TG,LDL-C and hs-CRP in the patients with uremic MHD(P<0.05).The ROC curve analysis results showed that the area under the curve of plasma ApoM for predicting lower extremity arterial lesions in the patients with uremic MHD was 0.933,the sensitivity was 0.912,and the specificity was 0.847.Conclusion The level of plasma ApoM is negatively correlated with TC,TG,LDL-C and hs-CRP and is a protective factor for lower extremity arterial lesions in the patients with uremic MHD.Clinically,it could help to predict the risk of lower extremity arterial lesions happening in the patients with uremic MHD.