血液透析患者血清沉默信息调节蛋白1、和肽素水平与远期主要不良心脑血管事件相关

Relationship between serum silent information regulatory protein 1,copeptin levels and long-term major adverse cardiovascular and cerebrovascular events in hemodialysis patients

目的探讨血液透析患者血清中沉默信息调节蛋白1(SIRT1)、和肽素(CPP)水平与远期主要不良心脑血管事件(MACCE)的关系。方法选取雅安市人民医院2018年6月1日至2020年6月1日收治的146例血液透析患者为观察组,选取同时段的健康体检者140例为对照组,根据3年随访是否发生MACCE,将观察组患者分为非MACCE组76例和MACCE组70例。采用酶联免疫吸附法检测血清中SIRT1、CPP水平并进行比较,比较非MACCE组与MACCE组临床资料,多因素Cox回归分析血液透析患者远期MACCE的影响因素,ROC曲线分析SIRT1、CPP水平对血液透析患者远期MACCE的预测价值。结果与对照组相比,观察组患者血清中SIRT1水平降低,CPP水平升高(t=21.783、17.893,P<0.05);MACCE组的透析龄、总胆固醇、高密度脂蛋白胆固醇、尿酸、CPP高于非MACCE组,低密度脂蛋白胆固醇、SIRT1低于非MACCE组(t=10.158、7.877、12.324、9.426、6.650、12.147、6.843,P<0.05)。透析龄、高密度脂蛋白胆固醇、尿酸、CPP是影响血液透析患者远期MACCE的危险因素,SIRT1是其保护因素(HR=2.916、3.274、3.247、3.716、0.759,P<0.05)。SIRT1、CPP以及两者联合预测血液透析患者远期MACCE的曲线下面积分别为0.754、0.849、0.876。结论血液透析患者血清中SIRT1水平降低,CPP水平升高,两者均可预测血液透析患者的远期MACCE。

Objective To investigate the relationship between serum levels of silent information regulatory protein 1(SIRT1),copeptin(CPP),and the occurrence of long-term major adverse cardiovascular and cerebrovascular events(MACCE)in hemodialysis patients.Methods A total of 146 hemodialysis patients admitted to Ya'an People's Hospital from June 1,2018 to June 1,2020 were selected as the observation group,and 140 healthy individuals undergoing physical examinations during the same period were selected as the control group.Based on the occurrence of MACCE over a 3-year follow-up,hemodialysis patients were grouped into a non-MACCE group with 76 cases and a MACCE group with 70 cases.Serum SIRT1 and CPP levels were measured using enzyme-linked immunosorbent assay(ELISA)and compared between groups.Clinical data were also compared between the nonMACCE group and MACCE group.Multivariate Cox regression analysis was used to identify factors influencing long-term MACCE in hemodialysis patients,and the predictive value of SIRT1 and CPP levels for long-term MACCE in hemodialysis patients was analyzed using receiver operating characteristic(ROC)curves.Results Compared with the control group,the hemodialysis patients had lower serum SIRT1 levels and higher CPP levels(t=21.783,17.893;P<0.05).In the MACCE group,dialysis duration,total cholesterol,high-density lipoprotein cholesterol(HDL-C),uric acid,and CPP levels were higher than those in the non-MACCE group,while low-density lipoprotein cholesterol(LDL-C)and SIRT1 levels were lower(t=10.158,7.877,12.324,9.426,6.650,12.147,6.843;P<0.05).Dialysis duration,HDL-C,uric acid,and CPP were identified as risk factors for long-term MACCE in hemodialysis patients,while SIRT1 was a protective factor(HR=2.916,3.274,3.247,3.716,0.759;P<0.05).The area under the ROC curve(AUC)for predicting long-term MACCE in hemodialysis patients was 0.754 for SIRT1,0.849 for CPP,and 0.876 for the combined prediction.Conclusion Hemodialysis patients have lower serum SIRT1 level and higher CPP level,and both can predict long-term MACCE in these patients.