血清SCUBE-1及EndoCan水平与血液透析患者动静脉内瘘血栓形成的关系

The relationship between serum SCUBE-1 and EndoCan levels and arteriovenous fistula thrombosis in hemodialysis patients

目的探讨血清SCUBE-1、EndoCan水平对血液透析(MHD)患者动静脉内瘘(AVF)血栓形成的关系。方法选取2018年6月~2020年6月我院收治的MHD并已行AVF的患者232例,随访24个月,根据AVF是否发生血栓,分为血栓组和非血栓组,比较两组MHD患者AVF血栓发生情况;单因素分析和多因素分析AVF血栓发生的危险因素;受试者工作特征(ROC)曲线分析血清信号肽-CUB-表皮生长因子结构域包含蛋白1(SCUBE1)、内皮细胞特异性分子-1(Endocan)水平单独及联合预测MHD患者AVF血栓发生的预测价值。结果随访过程中,有41例患者发生AVF血栓,血栓组和非血栓组SCUBE1、Endocan水平、年龄、糖尿病、血红蛋白、C反应蛋白、低密度脂蛋白胆固醇、低血压和普通肝素抗凝差异有统计学意义(均P<0.05);多因素COX回归分析结果提示,糖尿病病史、透析低血压、普通肝素抗凝、SCUBE1、Endocan水平为影响血栓发生的危险因素(P<0.05);SCUBE1、Endocan单独及联合预测AVF的AUC分别为0.813、0.912、0.939。结论SCUBE1、Endocan水平升高是AVF血栓形成的危险因素;SCUBE1、Endocan对AVF血栓预测具有较高诊断价值,对血清EndoCan>0.98 ng/mL、SCUBE-1>40 ng/mL的AVF患者应警惕其发生血栓的风险。

Objective To investigate the effect of serum SCUBE-1 and EndoCan levels on arteriovenous fistula(AVF)thrombosis in hemodialysis(MHD)patients.Methods Patients with MHD and AVF who were treated in our hospital from June 2018 to June 2020 were selected and followed up for 24 months.According to whether thrombosis occurred in AVF,they were divided into thrombosis group and non-thrombotic group.We compared the AVF thrombosis between two groups of MHD patients.Univariate and multivariate analysis analyzed the risk factors for AVF thrombosis;Receiver operating characteristic(ROC)curve analysis analyzed the predictive value of serum SCUBE-1 and EndoCan levels alone and in combination to predict AVF thrombosis in MHD patients.Results A total of 232 MHD patients were included.During the 24-month follow-up process,41 patients developed AVF.The levels of SCUBE1 and Endocan in the thrombosis group and the non-thrombotic group were statistically significant(P<0.05).Besides,the age,diabetes,hemoglobin,C reactive protein,low density lipoprotein cholesterol,hypotension and unfractionated heparin anticoagulation between two groups were statistically significant(P<0.05);Multivariate COX regression showed that the history of diabetes,dialysis hypotension,unfractionated heparin anticoagulation,SCUBE1 and Endocan levels were risk factors for thrombosis(P<0.05);The AUCs of SCUBE1 and Endocan alone and in combination to predict AVF were 0.813,0.912,and 0.939,respectively.Conclusion Increased levels of SCUBE1 and Endocan are risk factors for AVF thrombosis;SCUBE1 and Endocan have high diagnostic value for the prediction of AVF thrombosis,and AVF patients with serum EndoCan>0.98ng/mL and SCUBE-1>40ng/mL should be vigilant its risk of thrombosis.