甲襞微循环与血液透析患者心血管事件的相关性研究

A correlation study between nail fold microcirculation and cardiovascular events in hemodialysis patients

目的探讨血液透析患者甲襞微循环的特点及其与心血管事件的相关性。方法回顾性分析东莞东华医院2017年1月至2021年12月185例规律行血液透析患者的临床资料。其中,发生心血管事件76例(心血管事件组),未发生心血管事件109例(无心血管事件组)。采用甲襞微循环检测仪检测左手无名指甲襞真皮乳头第一排毛细血管的甲襞微循环,记录甲襞微循环指标及形态积分、流态积分、袢周积分、总积分。记录患者的一般资料和实验室指标(外周静脉血)。采用受试者工作特征(ROC)曲线评估甲襞微循环总积分预测血液透析患者发生心血管事件的价值。结果心血管事件组年龄、高血压比例、糖尿病比例、C反应蛋白(CRP)、碱性磷酸酶和氨基末端脑钠肽前体(NT-ProBNP)明显高于无心血管事件组[58(44,69)岁比49(40,63)岁、97.4%(74/76)比83.5%(91/109)、43.4%(33/76)比24.8%(27/109)、9.02(2.73,11.70)mg/L比3.76(1.28,11.70)mg/L、82(75,97)U/L比72(59,82)U/L和2652(1020,5359)ng/L比1894(780,4601)ng/L],肌酐、三酰甘油(TG)明显低于无心血管事件组[(961.95±277.11)μmol/L比(1058.93±284.66)μmol/L和(1.73±1.02)mmol/L比(2.27±2.02)mmol/L],差异有统计学意义(P<0.01或<0.05);两组性别构成、透析龄、透析时间、透析通路、血常规、血清铁、血清铁蛋白、总铁结合力、血清钾、血清钙、血清磷、甲状旁腺激素、尿素氮、白蛋白、总胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇比较差异无统计学意义(P>0.05)。两组红细胞聚集程度比较差异有统计学意义(P<0.05);两组血管袢数量、输入支管径、输出支管径、管袢长度、袢顶直径、血液流速、清晰度、交叉管袢情况、畸形管袢情况、乳头形态和乳头下静脉丛比较差异无统计学意义(P>0.05)。心血管事件组形态积分和总积分明显高于无心血管事件组[1.8(1.1,3.1)分比1.4(0.8,2.5)分和4.2(2.4,6.1)分比3.1(1.8,5.2)分],差异有统计学意义(P<0.05);两组流态积分和袢周积分比较差异无统计学意义(P>0.05)。ROC曲线分析结果显示,甲襞微循环总积分预测血液透析患者发生心血管事件的曲线下面积为0.590(95%CI 0.506~0.673),最佳截断值为2.85分,灵敏度为69.7%,特异度为45.9%。结论发生心血管事件的血液透析患者甲襞微循环障碍更严重,甲襞微循环检测可能有助于对心血管疾病的预测。

Objective To explore the characteristics of nail fold microcirculation in hemodialysis patients and its correlation with cardiovascular events.Methods The clinical data of 185 patients undergoing regular hemodialysis in Dongguan Donghua Hospital from January 2017 to December 2021 were retrospectively analyzed.Among them,there were 76 cases of cardiovascular events(cardiovascular events group)and 109 cases of no cardiovascular events(non-cardiovascular events group).The nail fold microcirculation detector was used to detect the nail fold microcirculation of the first row of capillaries in the nail fold dermal papilla of the left ring finger.The nail fold microcirculation indexes and morphology integral,flow integral,loop integral,total integral were recorded.The general information and laboratory indexes(peripheral venous blood)were recorded.The value of total integral of nail fold microcirculation in predicting the cardiovascular events in hemodialysis patients was evaluated using the receiver operating characteristics(ROC)curve.Results The age,proportion of hypertension,proportion of diabetes,C-reactive protein(CRP),alkaline phosphatase and N-terminal pro-brain natriuretic peptide(NT-ProBNP)in cardiovascular events group were significantly higher than those in non-cardiovascular events group:58(44,69)years vs.49(40,63)years,97.4%(74/76)vs.83.5%(91/109),43.4%(33/76)vs.24.8%(27/109),9.02(2.73,11.70)mg/L vs.3.76(1.28,11.70)mg/L,82(75,97)U/L vs.72(59,82)U/L and 2652(1020,5359)ng/L vs.1894(780,4601)ng/L,the creatinine and triglyceride(TG)were significantly lower than those in non-cardiovascular events group:(961.95±277.11)μmol/L vs.(1058.93±284.66)μmol/L and(1.73±1.02)mmol/L vs.(2.27±2.02)mmol/L,and there were statistical differences(P<0.01 or<0.05).There were no statistical differences in gender composition,dialysis age,dialysis time,dialysis pathway,blood routine,serum iron,serum ferritin,total iron binding capacity,serum potassium,serum calcium,serum phosphorus,parathyroid hormone,urea nitrogen,albumin,total cholesterol,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol between two groups(P>0.05).There was statistical difference in erythrocyte aggregation between two groups(P<0.05);there were no statistical differences in the number of vascular loops,diameter of input branch,diameter of output branch,length of loop,diameter of loop top,blood flow rate,clarity,condition of cross loop,condition of malformed loop,shape of nipple and subpapillary venous plexus between two groups(P>0.05).The morphology integral and total integral in cardiovascular events group were significantly higher than those in non-cardiovascular events group:1.8(1.1,3.1)scores vs.1.4(0.8,2.5)scores and 4.2(2.4,6.1)scores vs.3.1(1.8,5.2)scores,and there were statistical differences(P<0.05);there were no statistical differences in flow integral and loop integral between two groups(P>0.05).ROC curve analysis result showed that the area under the curve of the total integral of nail fold microcirculation for predicting cardiovascular events in hemodialysis patients was 0.590(95%CI 0.506 to 0.673),the best cut-off value was 2.85 scores,the sensitivity was 69.7%and the specificity was 45.9%.ConclusionsThe nail fold microcirculation disorder is more serious in hemodialysis patients with cardiovascular events.The nail fold microcirculation detection may help to predict cardiovascular disease.