腹膜透析患者腹透液中转化生长因子β_(1)、血管内皮生长因子、结缔组织生长因子水平可预测远期腹膜溶质转运功能改变

Effects of TGF-β_(1), VEGF and CTGF levels on peritoneal solute transport function in peritoneal dialysis patients

目的:探讨腹膜透析(PD)患者腹透液中转化生长因子β_(1)(TGF-β_(1))、血管内皮生长因子(VEGF)和结缔组织生长因子(CTGF)水平对腹膜溶质转运功能的影响。方法:选择广州市花都区人民医院肾病学科2017年1月-2019年9月收治的180例稳定持续非卧床PD患者,测量患者4 h透析液校正肌酐浓度与血浆校正肌酐浓度的比值(D/Pcr),根据D/Pcr值将患者分为低转运组(98例)和高转运组(82例),比较透析后1个月和6个月时腹透液中TGF-β_(1)、VEGF、CTGF水平。多因素logistic回归分析腹膜溶质转运功能的独立影响因素,Spearman相关性分析TGF-β_(1)、VEGF、CTGF与D/Pcr的相关性,受试者工作特征(ROC)曲线分析TGF-β_(1)、VEGF、CTGF水平对腹膜溶质转运功能的预测价值。结果:PD患者残肾功能、超敏C反应蛋白(hs-CRP)、TGF-β_(1)、VEGF和CTGF是腹膜溶质转运功能的独立影响因素。TGF-β_(1)、VEGF、CTGF水平均与D/Pcr呈正相关(r=0.724;0.691;0.713,P均<0.05),对远期腹膜溶质转运功能预测的曲线下面积分别为0.691、0.725、0.681,三者联合预测价值更高,曲线下面积为0.774。结论:患者腹透液中TGF-β_(1)、VEGF和CTGF的表达水平与腹膜溶质转运功能的变化密切相关,可作为预测远期腹膜溶质转运功能改变的指标。

Objective: To investigate the effects of transforming growth factor-β_(1)(TGF-β_(1)), vascular endothelial growth factor(VEGF) and connective tissue growth factor(CTGF) levels on peritoneal solute transport function in peritoneal dialysis patients.Methods: Totally, 180 patients receiving stable and continuous ambulatory peritoneal dialysis were selected from January 2017 to September 2019 in our hospital, and the ratio of 4-h dialysate-corrected creatinine concentration to plasma-corrected creatinine concentration(dialysate/plasmacreatinine, D/Pcr) was measured. According to the D/Pcr value, the patients were divided into low-transport group and high-transport group, and the general laboratory test indexes of the two groups were compared. The expression of TGF-β_(1), VEGF and CTGF in peritoneal dialysis fluid at 1 and 6 months after dialysis was detected. Multivariate logistic regression was used to analyze the independent influencing factors of peritoneal solute transport function and the correlation between TGF-β_(1), VEGF, CTGF and D/Pcr was analyzed by Spearman correlation analysis. Receiver operating characteristic(ROC) curve was used to analyze the predictive value of TGF-β_(1), VEGF, CTGF on peritoneal solute transport function. Results: The residual renal function, hypersensitive C-reactive protein(hs-CRP), TGF-β_(1), VEGF and CTGF were the independent factors of peritoneal lysate transport function. TGF-β_(1), VEGF, and CTGF were positively correlated with D/Pcr, and the area under the curve for the long-term peritoneal solute transport function prediction was 0.691, 0.725, and 0.681, respectively, and the combined area under the curve was 0.774, which was more predictive. Conclusion: The expression levels of TGF-β_(1), VEGF and CTGF in patients’ peritoneal dialysis fluid are closely related to the change of peritoneal solute transport function, and can be used as an index to predict the long-term change of peritoneal solute transport function.