Relationship between serum levels of FGF-23, sVCAM-1, MCP-1 and maturation of arteriovenous fistula in maintenance hemodialysis
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摘要: 目的 探讨血清成纤维细胞生长因子23(FGF-23)、可溶性血管细胞黏附分子1(sVCAM-1)、单核细胞趋化蛋白-1(MCP-1)表达水平与维持性血液透析(MHD)患者自体动静脉内瘘(AVF)成熟的关系。方法 选取2019年10月—2023年3月于医院首次行AVF成形术的MHD患者96例，根据术后内瘘成熟情况分为成熟组(70例)与成熟不良组(26例)。比较2组一般资料及血清FGF-23、sVCAM-1、MCP-1水平。采用多因素logistic回归分析AVF成熟不良的影响因素；采用受试者工作特征(ROC)曲线分析血清FGF-23、sVCAM-1、MCP-1预测AVF成熟不良的价值。结果 成熟不良组糖尿病肾病比例高于成熟组，头静脉内径、束臂后头静脉内径、桡动脉内径、桡动脉流速均低于成熟组，差异均有统计学意义(P < 0.05)。成熟不良组血清FGF-23、sVCAM-1、MCP-1水平均高于成熟组，差异均有统计学意义(P < 0.05)。Logistic回归分析显示，合并糖尿病肾病(OR=1.110，95%CI 1.027~1.200)、高FGF-23(OR=1.156，95%CI 1.045~1.325)、高sVCAM-1(OR=1.082，95%CI 1.001~1.125)、高MCP-1(OR=1.127，95%CI 1.100~1.285)是AVF成熟不良的危险因素(P < 0.05)。ROC曲线显示，血清FGF-23、sVCAM-1、MCP-1截断值分别为566.35 pg/mL、611.05 μg/L、51.98 pg/mL，预测AVF成熟不良的曲线下面积(AUC)分别为0.700、0.796、0.802；三项联合检测预测AVF成熟不良的AUC为0.926，均高于单项指标(P < 0.05)。结论 血清FGF-23、sVCAM-1、MCP-1水平升高是影响MHD患者AVF成熟的危险因素，且FGF-23、sVCAM-1、MCP-1对AVF成熟情况具有一定的预测价值，FGF-23、sVCAM-1、MCP-1或可作为预测AVF成熟的潜在生物标志物。
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关键词:
- 维持性血液透析 /
- 自体动静脉内瘘 /
- 成熟 /
- 成纤维细胞生长因子23 /
- 可溶性血管细胞黏附分子1 /
- 单核细胞趋化蛋白-1
Abstract: Objective To investigate the relationship between the expression levels of serum fibroblast growth factor-23(FGF-23), soluble vascular cell adhesion molecule-1(sVCAM-1), monocyte chemotactic protein-1(MCP-1) and the maturation of arteriovenous fistula(AVF) in patients with maintenance hemodialysis(MHD).Methods 96 MHD patients who underwent AVF plastic surgery for the first time in our Hospital from October 2019 to March 2023 were selected. They were divided into mature group(70 cases) and immature group(26 cases) based on the maturity of internal fistula after surgery. The general information and serum levels of FGF-23, sVCAM-1, and MCP-1 between the two groups were compared. The influencing factors for poor maturation of AVF were analyzed using logistic regression analysis. The value of serum FGF-23, sVCAM-1, and MCP-1 in predicting the poor maturation of AVF was analyzed using ROC curves.Results The proportion of diabetes nephropathy in the immature group was higher than that in the mature group(P < 0.05), the diameter of the cephalic vein, the diameter of the posterior cephalic vein, the diameter of the radial artery, and the flow velocity of the radial artery were lower than those in the mature group(P < 0.05). The levels of serum FGF-23, sVCAM-1, and MCP-1 in the immature group were higher than those in the mature group(P < 0.05). Logistic regression analysis showed that the diabetes nephropathy(OR=1.110, 95%CI 1.027-1.200), high FGF-23(OR=1.156, 95%CI 1.045-1.325), high sVCAM-1(OR=1.082, 95%CI 1.001-1.125), and high MCP-1(OR=1.127, 95%CI 1.100-1.285) were risk factors for poor maturation of AVF(P < 0.05). The ROC curve showed that: with the cut-off value of 566.35 pg/mL, 611.05 μg/L and 51.98 pg/mL, the AUC of serum FGF-23, sVCAM-1 and MCP-1 in predicting the poor maturation of AVF were 0.700, 0.796, and 0.802. The AUC of the three combined in predicting the poor maturation of AVF was 0.926, which was higher than the single indicator(P < 0.05).Conclusion The levels of serum FGF-23, sVCAM-1 and MCP-1 were risk factors for the maturation of AVF in MHD, and FGF-23, sVCAM-1 and MCP-1 might have certain predictive value for the maturation of AVF. FGF-23, sVCAM-1 and MCP-1 might serve as biomarkers in predicting the maturation of AVF. -
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表 1 2组一般资料比较
项目 成熟组(n=70) 成熟不良组(n=26) 校正χ2/χ2/t P 年龄/岁 45.75±8.95 47.97±10.33 1.035 0.303 性别/例(%) 0.002 0.961 男 40(57.14) 15(57.69) 女 30(42.86) 11(42.31) BMI 23.32±2.01 23.12±2.12 0.427 0.670 合并基础疾病/例(%) 慢性肾炎 35(50.00) 8(30.77) 2.825 0.092 糖尿病肾病 20(28.57) 14(53.85) 5.295 0.021 高血压肾疾病 12(17.14) 4(15.28) 0.011a) 0.918 其他 3(4.29) 0 0.170a) 0.680 头静脉内径/mm 2.52±0.33 2.20±0.30 4.323 < 0.001 头静脉血流速度/(cm/s) 7.42±2.01 6.50±2.35 1.902 0.060 束臂后头静脉内径/mm 3.46±0.42 3.00±0.45 4.678 < 0.001 桡动脉内径/mm 2.45±0.30 2.30±0.32 2.138 0.035 桡动脉流速/(cm/s) 55.35±10.33 47.32±8.41 3.547 0.001 桡动脉内膜中层厚度/mm 0.05±0.01 0.05±0.02 < 0.001 1.000 收缩压/mmHgb) 135.62±10.22 137.01±11.20 0.577 0.565 舒张压/mmHg 78.62±8.11 77.12±9.01 0.781 0.437 空腹血糖/(mmol/L) 6.10±1.01 6.58±1.22 1.953 0.054 总胆固醇/(mmol/L) 3.50±0.80 3.67±0.89 0.897 0.372 甘油三酯/(mmol/L) 1.55±0.60 1.65±0.71 0.690 0.492 高密度脂蛋白胆固醇/(mmol/L) 0.90±0.36 0.98±0.28 1.023 0.309 低密度脂蛋白胆固醇/(mmol/L) 1.90±0.45 1.74±0.50 1.502 0.136 血钙/(mmol/L) 1.90±0.50 1.98±0.58 0.667 0.507 血磷/(mmol/L) 1.65±0.40 1.70±0.36 0.559 0.578 全段甲状旁腺激素/(pg/mL) 428.35±125.32 415.32±118.50 0.459 0.647 血肌酐/(μmol/L) 680.01±22.35 682.01±20.01 0.400 0.690 尿酸/(μmol/L) 420.33±85.32 430.02±92.01 0.484 0.629 注：a)校正χ2；b)1 mmHg=0.133 kPa。 
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表 2 2组血清FGF-23、sVCAM-1、MCP-1水平比较
X±S 组别 例数 FGF-23/(pg/mL) sVCAM-1/(μg/L) MCP-1/(pg/mL) 成熟组 70 480.12±146.36 485.36±127.01 35.32±8.65 成熟不良组 26 600.35±180.33 650.33±155.32 55.36±10.33 t 3.0353 5.316 9.560 P 0.003 < 0.001 < 0.001
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表 3 多因素logistic回归分析AVF成熟不良的影响因素
项目 β SE Wald χ2 P OR 95%CI 糖尿病肾病 0.011 0.040 6.918 0.009 1.110 1.027~1.200 头静脉内径 -3.021 1.200 6.612 0.011 0.771 0.668~0.950 束臂后头静脉内径 0.946 0.158 0.355 0.551 2.575 0.115~57.748 桡动脉内径 -1.250 0.564 4.912 0.001 0.754 0.580~0.981 桡动脉流速 -0.234 0.089 7.433 0.006 0.748 0.659~0.934 FGF-23 0.145 0.060 5.840 < 0.001 1.156 1.045~1.325 sVCAM-1 0.256 0.119 4.628 0.032 1.082 1.001~1.125 MCP-1 0.012 0.030 16.000 < 0.001 1.127 1.100~1.285 常量 7.698 5.305 2.106 0.147
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表 4 血清FGF-23、sVCAM-1、MCP-1预测AVF成熟不良的价值
指标 截断值 灵敏度/% 特异度/% 约登指数 AUC 95%CI FGF-23 566.35 pg/mL 80.77 62.86 0.436 0.700 0.598~0.789 sVCAM-1 611.05 μg/L 88.46 58.57 0.470 0.796 0.702~0.872 MCP-1 51.98 pg/mL 88.46 65.71 0.542 0.802 0.708~0.876 三项联合 96.15 75.71 0.719 0.926 0.854~0.969
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