单核细胞/高密度脂蛋白比值对维持性血液透析患者血管钙化及心脑血管事件发生的预测价值

Predictive value of the monocyte/HDL ratio for vascular calcification and the occurrence of cardiovascular and cerebrovascular events in patients undergoing maintenance hemodialysis

目的探讨单核细胞/高密度脂蛋白比值(MHR)对维持性血液透析患者血管钙化及心脑血管事件发生的预测价值。方法对2021年5月至2023年5月洛阳市东方人民医院收治的85例维持性血液透析患者的临床资料进行回顾性分析,按照腹主动脉钙化情况将其分为钙化组(62例)和非钙化组(23例),之后按照腹主动脉钙化评分(AACS)对钙化组进行划分,其中轻度钙化组患者15例,中度钙化组患者29例,重度钙化组患者18例。采集所有研究对象基线资料,对其实验室指标进行检测并对比,将轻度、中度、重度钙化组患者MHR、钙/镁比值进行对比,采用多因素logistic回归分析筛选维持性血液透析患者发生血管钙化的危险因素,采用受试者工作特征(ROC)曲线分析MHR、钙/镁比值对维持性血液透析患者发生血管钙化的预测价值,对比钙化组和非钙化组患者心脑血管事件的发生率。结果非钙化组患者透析龄比钙化组短,血钙、甲状旁腺激素(iPTH)、MHR、钙/镁比值、成纤细胞生长因子23(FGF23)水平比钙化组低(P<0.05),而血红蛋白比钙化组高(P<0.05);中、重度钙化组患者MHR、钙/镁比值比轻度钙化组高,且重度钙化组患者上述指标比中度钙化组高(P<0.05);多因素logistic回归分析结果得出,透析龄、血磷、iPTH、MHR、钙/镁比值、FGF23均为维持性血液透析患者发生血管钙化的危险因素[OR值(95%CI)=7.838(3.368,18.243)、7.360(2.132,25.399)、8.306(2.369,29.119)、8.793(2.070,37.355)、2.457(1.096,5.510)、2.344(1.025,5.361),P<0.05];MHR、钙/镁比值预测维持性血液透析患者发生血管钙化的ROC曲线下面积分别为0.705、0.691;钙化组患者心脑血管事件发生率比非钙化组高,但差异无统计学意义(P>0.05)。结论MHR、钙/镁比值与维持性血液透析患者严重程度存在着密切的联系,将MHR、钙/镁比值用于对维持性血液透析患者是否发生血管钙化及心脑血管事件进行预测,具有较高的临床价值。

Objective To investigate the predictive value of monocyte/highdensity lipoprotein ratio(MHR)for the occurrence of vascular calcification and cardiovascular events in patients on maintenance hemodialysis.Methods The clinical data of 85 patients admitted to Dongfang People′s Hospital from May 2021 to May 2023 were divided into calcification group(62 cases)and noncalcification group(23 cases).and then,the calcification group was subdivided into 3 subgroups according to abdominal aortic calcification score(AACS),including 15 patients in mild calcification group,29 patients in moderate calcification group and 18 patients in severe calcification group.Baseline data were collected from all study subjects.We tested and compared their laboratory indicators,MHR and calcium/magnesium ratio in patients with mild,moderate and severe calcification group.Multivariate logistic regression analysis was used to screen the risk factors of vascular calcification in maintenance hemodialysis patients,receiver working characteristic(ROC)curve was used to analyze the predictive value of MHR and calcium/magnesium ratio for vascular calcification in maintenance hemodialysis patients,and the incidence of cerebrovascular events in the patients with calcification and noncalcified group was compared.Results In noncalcication group,patients had a shorter dialysis age than those in the calcified group.Blood calcium,parathyroid hormone(iPTH),MHR,calcium/magnesium ratio,fibroblast growth factor 23(FGF23)levels were lower than those in the calcified group.The hemoglobin was higher than that in the calcification group(all P<0.05).The moderate and calcium/magnesium ratio had higher MHR than the mild calcification group.Moreover,the above indexes were higher in patients with severe calcification than those in moderate calcification group(P<0.05).The results of the multivariate logistic regression analysis concluded,dialysis age,blood phosphorus,iPTH,MHR,calcium/magnesium ratio,and FGF23 were all risk factors for vascular calcification in patients on maintenance hemodialysis[OR(95%CI)=7.838(3.368,18.243)、7.360(2.132,25.399)、8.306(2.369,29.119)、8.793(2.070,37.355)、2.457(1.096,5.510)、2.344(1.025,5.361),All P<0.05].The area under the ROC of MHR and calcium/magnesium ratio for predicting vascular calcification in maintenance hemodialysis patients was 0.705 and 0.691,respectively.Higher incidence of cardiovascular and cerebrovascular events in the calcified group than in the noncalcified group,however,the difference was not significant(P>0.05).Conclusion There is close relationship between MHR,calcium/magnesium ratio and the severity of maintenance hemodialysis patients,and it has high clinical value to use MHR and calcium/magnesium ratio to predict the occurrence of vascular calcification and cardiovascular and cerebrovascular events in maintenance hemodialysis patients.