维持性血液透析患者血浆生长停滞特异性蛋白6水平与动静脉内瘘血栓形成的关系

Relationship between plasma Gas6 level and arteriovenous fistula thrombosis in maintenance hemo⁃dialysis patients

目的检测生长停滞特异性蛋白6(growth arrest specific protein 6,Gas6)在维持性血液透析(maintenance hemodialysis,MHD)患者血浆中的表达情况,探讨Gas6与MHD患者动静脉内瘘血栓形成的相关性。方法选择2017年10月至2019年11月在郴州市第四人民医院行自体动静脉内瘘术的MHD患者165例作为观察对象(MHD组),其中无动静脉内瘘血栓形成患者108例(无动静脉内瘘血栓形成组),有动静脉内瘘血栓形成患者57例(有动静脉内瘘血栓形成组);另选同期健康体检人员150名作为对照组。收集MHD患者糖尿病史、高血压史及血液生化指标等资料,采用酶联免疫吸附法检测各观察对象血浆Gas6水平,受试者工作曲线(receiver operating curve,ROC)曲线分析血浆Gas6对MHD患者动静脉内瘘血栓形成的诊断价值,Logistic回归分析影响MHD患者动静脉内瘘血栓形成的因素。结果MHD组患者血浆Gas6水平显著高于对照组(P<0.05);与无动静脉内瘘血栓形成组比较,有动静脉内瘘血栓形成组患者糖尿病比例、普通肝素使用比例、低密度脂蛋白(lowdensity lipoprotein,LDL)、C反应蛋白、D-二聚体、血小板、纤维蛋白原、血红蛋白、血磷、血浆Gas6水平显著升高,收缩压及舒张压显著降低(P<0.05);ROC曲线分析显示,血浆Gas6预测MHD患者动静脉内瘘血栓形成的敏感度为85.96%,特异性为82.41%,截断值为18.33μg/L,曲线下面积为0.860;Logistic回归分析结果显示,糖尿病、LDL、D-二聚体、超滤量、Gas6是MHD患者动静脉内瘘血栓形成的危险因素(P<0.05)。结论Gas6在有动静脉内瘘血栓形成的MHD患者血浆中水平较高,可能作为预测MHD患者动静脉内瘘血栓形成的潜在标志物.

Objective To detect the expression of growth arrest-specific protein 6(Gas6)in the plasma of maintenance hemodialysis(MHD)patients and explore the correlation between Gas6 and arte⁃riovenous fistula thrombosis.Methods From October 2017 to November 2019,165 MHD patients un⁃dergoing autologous arteriovenous fistula surgery were selected as observation subjects(MHD group),including 108 thrombosis patients without arteriovenous fistula(thrombosis without internal arteriovenous fistula group)and 57 thrombosis patients with arteriovenous fistula(thrombosis with internal arteriove⁃nous fistula group);another 150 cases of healthy physical examination during the same period were se⁃lected as control group.Histories of diabetes mellitus and hypertension and blood biochemical parameters were recorded.Enzyme-linked immunosorbent assay was utilized for measuring the plasma Gas6 level,receiver operating curve(ROC)curve for detecting the diagnostic value of plasma Gas6 for arteriovenous fistula thrombosis and Logistic regression for examining the influencing factors of arteriovenous fistula thrombosis.Results The plasma Gas6 level was significantly higher in MHD group than that in control group(P<0.05);Compared with thrombosis without internal arteriovenous fistula group,proportion of diabetics,proportion of patients with unfractionated heparin,low-density lipoprotein(LDL),C-reactive protein(CRP),D-dimer,platelets(PLT),fibrinogen(FIB),hemoglobin(Hb),blood phosphorus and plasma Gas6 level were significantly elevated in arteriovenous fistula thrombosis group.Systolic and diastolic blood pressures dropped obviously(P<0.05);ROC curve analysis showed that the sensitivity of plasma Gas6 was 85.96%for predicting arteriovenous fistula thrombosis.The specificity was 82.41%with a cut-off value of 18.33μg/L and area under the curve of 0.860.Logistic regression analysis indi⁃cated that diabetes mellitus,LDL,D-dimer,ultrafiltration volume and Gas6 were risk factors for arterio⁃venous fistula thrombosis in MHD patients(P<0.05).Conclusion With a high plasma level in MHD patients with arteriovenous fistula thrombosis,Gas6 may become a potential marker for predicting arterio⁃venous fistula thrombosis in MHD patients.