维持性血液透析患者血清热休克蛋白70及簇集蛋白水平与主要不良心血管事件的相关性

Relationship between major adverse cardiovascular events and serum levels of heat shock protein 70 and clusterin in patients undergoing maintenance hemodialysis

目的:探讨血清热休克蛋白70(HSP-70)、簇集蛋白水平与维持性血液透析患者主要不良心血管事件(MACE)的相关性。方法:选取183例接受维持性血液透析的终末期肾病患者为研究对象,记录患者基线资料,根据患者1年随访期间MACE发生情况分为MACE组57例和非MACE组126例。采用酶联免疫吸附法检测血清HSP-70、簇集蛋白水平;受试者工作特征(ROC)曲线方法分析血清HSP-70、簇集蛋白水平在评估MACE中的价值;多因素Logistic回归方法分析MACE的影响因素。结果:MACE组的血清HSP-70、簇集蛋白、甘油三酯及甲状旁腺激素水平高于非MACE组(t=7.763、8.550、4.156、4.908),左室射血分数低于非MACE组(t=10.931),差异均有统计学意义(P<0.05)。血清HSP-70、簇集蛋白单独及联合评估MACE的曲线下面积分别为0.757、0.859、0.903。HSP-70和簇集蛋白是影响维持性血液透析终末期肾病患者MACE发生的独立影响因素(OR=2.947、3.074,95%CI:1.549~5.605、1.691~5.589,P<0.05)。结论:在并发MACE的维持性血液透析患者中,血清HSP-70和簇集蛋白水平升高,并是MACE发生的影响因素。临床上评估MACE事件发生的风险时,血清HSP-70和簇集蛋白水平可以作为参考指标。

Objective To investigate the relationship between major adverse cardiovascular events(MACE)and serum levels of heat shock protein 70(HSP-70)and clusterin in patients undergoing maintenance hemodialysis.Methods A total of 183 end-stage renal disease patients undergoing maintenance hemodialysis were selected as the study subjects whose baseline data were recorded.And the patients were divided into the MACE group(57 cases)and the non-MACE group(126 cases)based on MACE during the one-year follow-up.Enzyme-linked immunosorbent assay(ELISA)was applied to measure the serum levels of HSP-70 and clusterin.Receiver operating characteristic(ROC)curve was applied to analyze the value of serum HSP-70 and clusterin in evaluating occurrence of MACE in the patients.Multivariate logistic regression method was used to analyze the affecting factors for occurrence of MACE in the patients.Results The serum levels of HSP-70,clusterin,triglyceride,and parathyroid hormone of the MACE group were higher than those of the non-MACE group(t=7.763,8.550,4.156,4.908,respectively),while LVEF was lower than that of the non-MACE group(t=10.931)(P<0.05).The AUC of serum HSP-70,clusterin,and HSP-70 plus clusterin in evaluating MACE in the patients was 0.757,0.859,and 0.903,respectively.HSP-70 and clusterin were independent affecting factors for MACE occurrence in the patients(OR=2.947,3.074,respectively;95%CI:1.549-5.605,1.691-5.589,respectively;P<0.05).Conclusion In maintenance hemodialysis patients complicated with MACE,elevated levels of serum HSP-70 and clusterin were influencing factors for the occurrence of MACE.When evaluating the risk of MACE occurrence in clinical practice,serum HSP-70 and clusterin might serve as reference indicators.