TyG指数、血清CCL18及骨硬化蛋白对维持性血液透析并发心血管事件的预测价值

Predictive value of TyG index,serum CCL18,and osteosclerosis protein for cardiovascular events in maintenance hemodialysis patients

目的 探讨甘油三酯葡萄糖(TyG)指数、血清趋化因子配体18(CCL18)及骨硬化蛋白(SOST)对维持性血液透析并发心血管事件的预测价值。方法 选取2019年1月至2021年1月潍坊市人民医院收治的100例维持性血液透析患者,随访2年,根据是否并发心血管事件分为并发心血管事件组(n=30)和未并发心血管事件组(n=70),另选取50名同期来本院体检的健康者作为对照组。对比3组受检者TyG指数、CCL18及SOST表达水平,采用Spearman相关性分析对TyG指数、CCL18及SOST与维持性血液透析并发心血管事件的相关性进行分析。随后进行维持性血液透析并发心血管事件的单因素分析,并将其纳入多因素Logistic回归模型,分析血液透析并发心血管事件的独立影响因素。最后分析TyG指数、CCL18联合SOST检测的预测价值。结果 3组受检者TyG指数、CCL18联合SOST表达水平对比差异显著,并发心血管事件组患者的TyG指数、CCL18及SOST表达水平分别为9.46±2.46、(89.80±13.82) ng/mL、(121.27±13.35) pmol/L,均明显高于未并发心血管事件组[9.46±2.46、(89.80±13.82) ng/mL、(121.27±13.35) pmol/L]和对照组[9.46±2.46、(89.80±13.82) ng/mL、(121.27±13.35) pmol/L],差异均有统计学意义(P<0.05)。Spearman相关分析结果显示:TyG指数、CCL18及SOST与维持性血液透析并发心血管事件呈正相关(P<0.05)。单因素分析结果显示,TyG指数、CCL18、SOST、合并高血脂、合并高血压、合并糖尿病、吸烟史、高磷血症、透析时间是维持性血液透析并发心血管事件的危险因素(P<0.05)。进一步行多因素Logiscic回归分析结果显示,TyG指数、CCL18、SOST、合并高血脂、合并高血压、合并糖尿病、高磷血症是维持性血液透析并发心血管事件的独立危险因素(P<0.05)。TyG指数、CCL18联合SOST预测维持性血液透析并发心血管事件的敏感度和特异度达到94.24%和85.72%,曲线下面积值为0.892。结论 TyG指数、CCL18及SOST水平升高为维持性血液透析并发心血管事件的独立影响因素,且三者联合检测可对维持性血液透析并发心血管事件的发生进行可靠预测。

Objective To explore the predictive value of Triacylglycerol glucose(TyG) index,serum chemokine ligand 18(CCL18),and osteosclerotic protein(SOST) in cardiovascular events during maintenance hemodialysis.Methods A total of 100 maintenance hemodialysis patients admitted to Weifang People's Hospital from January 2019 to January 2021 and followed up for 2 years were divided into concurrent cardiovascular events group(n=30) and no concurrent cardiovascular events group(n=70) according to where they had cardiovascular events.In addition,50 healthy individuals who came to our hospital for physical examination during the same period were selected as the control group.The TyG index,CCL18,and SOST expression levels of the three groups of patients were compared,spearman correlation analysis was used to analyze the correlation between TyG index,CCL18,and SOST and cardiovascular events in maintenance hemodialysis patients.Subsequently,a univariate analysis was conducted on maintenance hemodialysis complicated with cardiovascular events,and it was included in the multivariate Logistic regression model to analyze the independent influencing factors of hemodialysis complicated with cardiovascular events.Finally,the predictive value of TyG index,CCL 18 combined with SOST detection was analyzed.Results There were differences in the expression levels of TyG index and CCL18 and SOST among the three groups of subjects.The TyG index and CCL18 and SOST expression levels of patients in concurrent cardiovascular events group were 9.46±2.46,(89.80±13.82) ng/mL,(121.27±13.35) pmol/L,which were higher than those in the non concurrent cardiovascular event group[9.46±2.46,(89.80±13.82) ng/mL,(121.27±13.35) pmol/L] and the control group[9.46±2.46,(89.80±13.82) ng/mL,(121.27±13.35) pmol/L],the differences were statistically significant(P<0.05).The Spearman correlation analysis results showed that the TyG index,CCL18,and SOST were positively correlated with cardiovascular events during maintenance hemodialysis(P<0.05).The results of single factor analysis showed that TyG index,CCL18,SOST,hyperlipidemia,hypertension,diabetes,smoking history,hyperphosphatemia,and dialysis time were risk factors(P<0.05).The results of multivariate Logistic regression analysis showed that TyG index,CCL18,SOST,hyperlipidemia,hypertension,diabetes and hyperphosphatemia were independent risk factors for cardiovascular events in maintenance hemodialysis(P<0.05).The sensitivity and specificity of TyG index,CCL18 combined with SOST in predicting cardiovascular events during maintenance hemodialysis reached 94.24% and 85.72%,with an AUC value of 0.892.Conclusion Elevated levels of TyG index,CCL18,and SOST are independent influencing factors for cardiovascular events in maintenance hemodialysis,and their combined detection can reliably predict the occurrence of cardiovascular events in maintenance hemodialysis.