血清VEGF联合瘦组织指数对维持性血液透析患者动静脉内瘘功能丧失的预测价值

Predictive value of serum VEGF combined with lean tissue index for arteriovenous fistula dysfunction in maintenance hemodialysis patients

目的探讨血清血管内皮生长因子(VEGF)联合瘦组织指数(LTI)对维持性血液透析(MHD)患者动静脉内瘘功能丧失(AFD)的预测价值。方法选取MHD患者203例,根据是否发生AFD将MHD患者分为AFD组90例、非AFD组113例。用酶联免疫吸附法检测血清VEGF,用身体成分分析仪测算LTI,收集MHD患者临床资料。用多因素Logistic回归分析MHD患者发生AFD的影响因素;绘制受试者工作特征(ROC)曲线,用曲线下面积分析血清VEGF、LTI对MHD患者发生AFD的预测价值。结果AFD组血清VEGF水平高于非AFD组,LTI低于非AFD组(P均<0.05)。AFD组年龄大于非AFD组,透析龄长于非AFD组,血钙、血磷、低密度脂蛋白胆固醇高于非AFD组,血红蛋白低于非AFD组(P均<0.05),两组性别、BMI、MHD病因、血压比较差异无统计学意义(P均>0.05)。多因素Logistic回归分析结果显示,透析龄长和血磷、LDL-C、VEGF升高为MHD患者发生AFD的独立危险因素(P均<0.05),LTI升高为独立保护因素(P<0.05)。ROC曲线分析显示,血清VEGF和LTI单独与联合预测MHD患者发生AFD的曲线下面积分别为0.776、0.784、0.871,VEGF联合LTI预测的曲线下面积大于二者单独预测(P均<0.05)。结论VEGF升高和LTI降低与MHD患者发生AFD独立相关,二者联合预测MHD患者发生AFD的价值较高。

Objective To investigate the predictive value of serum vascular endothelial growth factor(VEGF)combined with lean tissue index(LTI)for arteriovenous fistula dysfunction(AFD)in patients undergoing maintenance hemodialysis(MHD).Methods Totally 203 patients with MHD were selected and were divided into the AFD group of 90 cases and the non-AFD group of 113 cases according to whether AFD occurred.Serum VEGF was measured by enzyme-linked immunosorbent assay and LTI was measured by body composition analyzer,and we collected the clinical information from MHD patients.Multi-factor Logistic regression was used to analyze the factors influencing the development of AFD in MHD patients.The predictive value of serum VEGF and LTI on the development of AFD in MHD patients was analyzed by plotting receiver operating characteristic(ROC)curve and using the area under the curve.Results Serum VEGF level was higher in the AFD group than in the non-AFD group,and LTI was lower than in the non-AFD group(both P<0.05).Patients in the AFD group were older than patients in the non-AFD group,and their dialysis age was longer;the blood calcium,blood phosphorus,and low-density lipoprotein cholesterol(LDL-C)in the AFD group were higher than those in the non-AFD group,and hemoglobin was lower than that of the non-AFD group(all P<0.05).There were no differences in the gender,body mass index(BMI),cause of MHD,and blood pressure between the two groups(all P>0.05).Multi-factor Logistic regression analysis showed that long dialysis age and elevated blood phosphorus,LDL-C and VEGF were independent risk factors for the development of AFD in MHD patients(all P<0.05),and elevated LTI was an independent protective factor(P<0.05).ROC curve analysis showed that the area under the curve for serum VEGF and LTI alone and in combination in predicting the development of AFD in patients with MHD was 0.776,0.784,and 0.871 respectively,with a larger area under the curve of VEGF in combination with LTI than that of either alone(all P<0.05).Conclusions Elevated VEGF and reduced LTI were independently associated with the development of AFD in patients with MHD,and VEGF combined with LTI was of high value in predicting the development of AFD in patients with MHD.