于平^1,2,,
邹春波^2,,
1. 大连医科大学 研究生院, 辽宁 大连 116044
2. 泰州市人民医院 肾内科, 江苏 泰州 225300

详细信息 作者简介: 于平(1995-), 女, 硕士研究生。E-mail: 1799653506@qq.com


通讯作者: 邹春波, 教授。E-mail: shilz123@yeah.net 中图分类号: R446.11


摘要:目的了解维持性血液透析(maintenance hemodialysis, MHD)患者主动脉弓钙化发生情况, 分析微炎症与MHD患者主动脉弓钙化的相关性。方法选取2018年10月至2020年12月在泰州市人民医院血液净化中心进行规律血液透析的MHD患者71例, 收集患者的一般临床资料、临床生化结果。采用酶联免疫吸附法(enzyme linked immunosorbent assay, ELISA)检测白介素-37(interleukin-37, IL-37)。胸部X线计算主动脉弓钙化评分, 依据评分分为无钙化/轻度钙化组30例(42%)和中重度钙化41例(58%)两组。比较两组患者的一般临床资料、临床生化结果及IL-37;采用Spearman法分析钙化程度与各指标之间的相关性; logistic回归分析钙化的影响因素; ROC曲线评估血小板/淋巴细胞计数(platelet to lymphocyte ratio, PLR)对于主动脉弓中重度钙化的敏感性及特异性。结果中重度钙化组年龄、透析年限、矫正钙均高于无钙化/轻度钙化组, 差异均有统计学意义(P＜0.05)。生化指标: 中重度钙化组中性粒细胞计数/淋巴细胞计数(neutrophil to lymphocyte ratio, NLR)、PLR、IL-37均高于无钙化/轻度钙化组, 活性维生素D、非含钙磷结合剂均低于无钙化/轻度钙化组, 差异均有统计学意义(P＜0.05)。血管钙化程度与IL-37、NLR、PLR、年龄、矫正钙、透析年限呈正相关(均P＜0.05), 与活性维生素D、非含钙磷结合剂呈负相关(均P＜0.05)。二元多因素logistic回归分析提示: 透析年限、高PLR是MHD患者主动脉弓钙化发生的独立危险因素。利用ROC曲线分析PLR预测中重度主动脉弓钙化, 其中PLR敏感性为85.4%, 最佳截断值为90.305, 曲线下面积为0.698(95%CI为0.572~0.825, P＜0.05)。结论MHD患者普遍存在主动脉弓钙化, 透析年限、高PLR是MHD患者主动脉弓钙化独立危险因素, 钙化程度与IL-37、NLR、PLR呈正相关, PLR对于MHD患者主动脉弓钙化具有良好的预测价值。
关键词: 维持性血液透析/
血小板/淋巴细胞计数比值/
主动脉弓钙化/
微炎症


Abstract:ObjectiveTo understand the incidence of aortic arch calcification in patients with Maintenance hemodialysis (MHD) and the correlation between microinflammation and aortic arch calcification in MHD patients.MethodsSeventy-one MHD patients, who met the inclusion criteria and underwent regular hemodialysis in Taizhou People's Hospital Blood Purification Center from October 2018 to December 2020, were selected. General clinical data and clinical biochemical results of the patients were collected. IL-37 was detected by enzyme linked immunosorbent assay. Aortic arch calcification score was calculated by chest X-ray and divided into two groups according to the score: 30 patients (42%) had no-calcification/mild calcification and 41 patients (58%) had moderate-to-severe calcification. The general clinical data, clinical biochemical results and IL-37 were compared between the two groups. Spearman method was used to analyze the correlation between the degree of calcification and each index. The influencing factors of calcification were analyzed by logistic regression. ROC curves were used to assess the sensitivity and specificity of PLR for moderate and severe aortic arch calcification.ResultsThe age, dialysis years and corrected calcium of moderate-to-severe calcification group were higher than those of no-calcification/mild calcification group (P < 0.05). Biochemical indexes were as follows: NLR, PLR and IL-37 in moderate-to-severe calcification group were higher than those in no-calcification/mild calcification group, while active vitamin D and non-calcium-phosphorus binding agent were lower than those in no-calcification/mild calcification group (P < 0.05). The degree of vascular calcification was positively correlated with IL-37, NLR, PLR, age, corrected calcium and dialysis years (all P < 0.05), and negatively correlated with active vitamin D and non-calcium-phosphorus binders (all P < 0.05). Binary multiple Logistic regression analysis suggested that dialysis years and high PLR were independent risk factors for aortic arch calcification in MHD patients. PLR was used to predict moderate-to-severe aortic arch calcification using ROC curve analysis. The sensitivity of PLR was 85.4%, the optimal cut-off value was 90.305, and the area under the curve was 0.698 (95%CI was 0.572-0.825, P < 0.05).ConclusionAortic arch calcification is common in MHD patients. Dialysis years and high PLR are independent risk factors for aortic arch calcification in MHD patients. The degree of calcification is positively correlated with IL-37, NRL and PLR, and PLR has good predictive value for aortic arch calcification in MHD patients.
Keywords:maintenance hemodialysis/
platelet-to-lymphocyte ratio/
calcification of the aortic arch/
microinflammation

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