平均血小板体积和平均血小板体积/血小板计数比值对血液透析患者血管通路失功的潜在预测价值

Potential predictive value of mean platelet volume and ratio of mean platelet volume to platelet count in vascular access failure of hemodialysis patients

目的探讨平均血小板体积(MPV)和平均血小板体积/血小板计数比值(MPV/PLT)与血液透析患者血管通路失功(VAF)的相关性,评估MPV和MPV/PLT对VAF的潜在预测价值。方法本研究为单中心回顾性研究。选取2015年1月至2021年6月北京朝阳医院肾内科血液净化中心以自体动静脉内瘘(AVF)为血管通路的维持性血液透析患者为研究对象,以是否发生血管通路功能障碍分为血管通路失功(VAF)组和非血管通路失功(非VAF)组。应用混合线性模型比较两组的MPV和MPV/PLT变化差异,Kaplan-Meier曲线比较不同MPV及MPV/PLT水平的VAF发生率,多因素Cox回归模型分析VAF发生的独立危险因素,以受试者工作特征(ROC)曲线评估MPV、MPV/PLT对血液透析患者VAF的预测价值。结果本研究共纳入307例MHD患者,其中VAF组99例、非VAF组208例。VAF组患者MPV、MPV/PLT、总胆固醇、尿酸、透析龄均较非VAF组高(P均<0.05)。混合线性模型比较发现,两组MPV无显著差异,而VAF组的MPV/PLT随着随访时间延长则显著高于非VAF组(P<0.001)。Kaplan-Meier曲线显示在不同MPV和MPV/PLT水平,VAF发生率的差异均有统计学意义(χ^(2)=30.580,P<0.001和χ^(2)=9.599,P=0.008)。MPV、MPV/PLT水平越高,VAF发生率越高。矫正总胆固醇、尿酸、透析龄后,多因素Cox回归模型分析显示MPV(HR=1.97,95%CI:1.60~2.42,P<0.001)、MPV/PLT(HR=1.59,95%CI:1.32~1.92,P<0.001)是VAF发生的独立危险因素。MPV和MPV/PLT的ROC曲线下面积(AUC)分别为0.713和0.643,两者联合预测的AUC为0.716。结论维持性血液透析患者MPV和MPV/PLT增高与VAF发生相关,对VAF事件发生具有潜在的预测价值。

Objective To investigate the correlation of mean platelet volume(MPV)and MPV to platelet count ratio MPV/PLT with vascular access failure(VAF)in maintenance hemodialysis(MHD)patients,and to evaluate the predictive value of MPV and MPV/PLT for VAF events.MethodsThis study was a single center retrospective study.MHD patients with autologous arteriovenous fistula(AVF)as the vascular access at the Renal Blood Purification Center of Beijing Chaoyang Hospital from January 2015 to June 2021 were selected.The study subjects were divided into two groups based on the occurrence of vascular dysfunction:VAF group and non-VAF group.The differences in MPV and MPV/PLT changes between the two groups were compared with the mixed linear model.Kaplan Meier curve was used to compare the VAF incidence at different levels of MPV and MPV/PLT.The multivariate Cox regression model was applied to analyze independent risk factors for VAF events.The receiver operating characteristic(ROC)curve was used to evaluate the value of MPV and MPV/PLT in predicting VAF events in the hemodialysis patients.ResultsThis study included 307 MHD patients,with 99 in the VAF group and 208 in the non-VAF group.The MPV,MPV/PLT,total cholesterol,uric acid,and dialysis age of the VAF group were higher than those of the non-VAF group(P<0.05).The mixed linear model comparison showed that there was no significant difference in MPV between the two groups,while MPV/PLT of the VAF group was significantly higher than that of the non-VAF group with the follow-up time prolonging(P<0.001).The Kaplan Meier curve showed statistically significant differences in the incidence of VAF at different levels of MPV and MPV/PLT(χ^(2)=30.580,P<0.001 andχ^(2)=9.599,P=0.008).The higher the levels of MPV and MPV/PLT,the higher the incidence of VAF events.After correction for the total cholesterol,uric acid,and dialysis age,multivariate Cox regression model analysis showed that MPV(HR=1.97,95%CI:1.60-2.42,P<0.001)and MPV/PLT(HR=1.59,95%CI:1.32-1.92,P<0.001)were independent risk factors for the occurrence of VAF.The area under the ROC curve(AUC)were 0.713 and 0.643,respectively,while the AUC of the combination of them was 0.716.ConclusionsElevated levels of MPV and MPV/PLT in the MHD patients were associated with the occurrence of VAF,and might have potential predictive value.