MMP-2和PAF及RDW水平在终末期肾病透析患者血管通路功能中的评估价值

Evaluation the levels of MMP-2,PAF and RDW in vascular access function in patients with end-stage renal disease dialysis

目的探讨终末期肾病(ESRD)血液透析患者血清基质金属蛋白酶-2(MMP-2)、血小板活化因子(PAF)、红细胞分布宽度(RDW)表达水平,及其对血管通路功能的评估价值。方法选择2021年3月-2023年3月在资阳市第一人民医院定期进行血液透析的ESRD患者130例为研究对象进行回顾性分析,根据在维持性血液透析治疗期间是否发生血管通路失功(VAF)将患者分为血管通路(VA)正常组(n=71)及VAF组(n=59)。比较两组患者一般资料及MMP-2、PAF、RDW水平。采用多因素logistic回归分析ESRD透析患者出现VAF的影响因素;绘制受试者工作特征(ROC)曲线分析血清MMP-2、PAF、RDW对ESRD透析患者发生VAF的诊断价值。结果VAF组血清MMP-2、PAF、RDW水平均高于VA正常组,差异均有统计学意义(t=6.133、6.693、6.827,P均<0.05)。VAF组合并高血压及糖尿病的比例均高于VA正常组,差异均有统计学意义(χ^(2)=4.710、4.970,P均<0.05)。多因素logistic分析显示,合并高血压、糖尿病以及血清MMP-2、PAF、RDW水平升高均是ESRD透析患者发生VAF的危险因素(P均<0.05)。ROC曲线显示,血清MMP-2、PAF、RDW及三者联合检测诊断ESRD透析患者VAF发生的曲线下面积(AUC)分别为0.778、0.782、0.815、0.911。结论在VAF的ESRD透析患者中血清MMP-2、PAF、RDW水平异常升高,是影响VAF发生的危险因素,三者联合检测对于诊断ESRD透析患者VAF发生具有较好的应用价值。

Objective To investigate the value of serum matrix metalloproteinase-2(MMP-2), platelet activating factor(PAF) and red blood cell distribution width(RDW) in evaluating vascular access function in hemodialysis patients with endstage renal disease(ESRD). Methods A retrospective analysis was performed on 130 ESRD patients who underwent regular hemodialysis in the Ziyang First People's Hospital from March 2021 to March 2023. The patients were divided into vascular access(VA) normal group(n=71) and vascular access failure(VAF) group(n=59) according to whether VAF occurred during maintenance hemodialysis. The general data and the levels of MMP-2, PAF and RDW were compared between the two groups. Multivariate logistic regression was used to analyze the influencing factors of VAF in ESRD dialysis patients. The receiver operating characteristic(ROC) curve was drawn to analyze the diagnostic value of serum MMP-2, PAF and RDW for VAF in ESRD dialysis patients. Results The levels of serum MMP-2, PAF and RDW in the VAF group were higher than those in the VA normal group, and the differences were statistically significant(t=6.133, 6.693, 6.827;all P<0.05). The proportion of hypertension and diabetes in the VAF group were higher than those in the normal VA group, and the differences were statistically significant (χ^(2)=4.710, 4.970;all P<0.05). Multivariate logistic regression analysis showed that hypertension, diabetes and elevated levels of serum MMP-2, PAF and RDW were risk factors for VAF in ESRD dialysis patients(all P<0.05). The results of ROC curve showed that the area under the curve(AUC) of serum MMP-2, PAF, RDW and their combined detection in the diagnosis of VAF in ESRD dialysis patients were 0.778, 0.782, 0.815 and 0.911, respectively. Conclusions The levels of serum MMP-2, PAF and RDW in ESRD dialysis patients with VAF were abnormally increased, and the increase of the above indexes was a risk factor affecting the occurrence of VAF. The combined detection of MMP-2, PAF and RDW had a good application value for the diagnosis of VAF in ESRD dialysis patients.