| 南娜佳.血浆Obestatin和精氨酸加压素水平在终末期肾病血液透析效果和预后中应用[J].浙江中西医结合杂志,2021,31(5): |
| 血浆Obestatin和精氨酸加压素水平在终末期肾病血液透析效果和预后中应用 |
| The clinical value of the plasma levels of Obestatin and AVP to the hemodialysis effect and prognosis in patients with end stage renal disease |
| 投稿时间：2020-08-26 修订日期：2021-03-17 |
| DOI： |
| 中文关键词: 终末期肾病 肥胖抑制素 精氨酸加压素 预后 血液透析 |
| 英文关键词:end stage renal disease, Obestatin, arginine vasopressin, prognosis, hemodialysis |
| 基金项目: |
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| 中文摘要: |
| 目的：探讨血浆肥胖抑制素(Obestatin)和精氨酸加压素(AVP)水平对评估终末期肾病(ESRD)患者血液透析效果与预后结局的临床价值。方法：选择90例本院行维持性血液透析治疗的ESRD患者为观察组,同时选取50名肾功能正常体检者作为对照组。比较两组血浆Obestatin、AVP、肾小球滤过率(GFR)、脑钠肽(BNP)、血肌酐(Scr)、血清白蛋白(Alb)、甲状旁腺激素(PTH)水平的差异。采用Pearson相关分析评估观察组血浆Obestatin以及AVP分别与GFR、SCr、BNP、Alb、PTH相关性。随访12月,根据ESRD患者预后生存情况分为：生存组,共56例；死亡组,共34例。比较两组血浆Obestatin、AVP、GFR、SCr、BNP、Alb及PTH差异。应用多元Logistic回归分析与随访12月ESRD患者生存相关的危险因素。绘制受试者工作特征曲线(ROC)评估血浆Obestatin以及AVP对随访12月ESRD患者预后的评估价值。结果：与对照组比较,观察组血浆Obestatin、AVP、SCr、BNP水平明显升高(均P<0.05),而GFR、Alb、PTH水平明显降低(均P<0.05)。Pearson相关分析,ESRD患者血浆Obestatin及AVP值分别与GFR呈负相关(P<0.05),与SCr及BNP呈正相关(P<0.05)。生存组ESRD患者的血浆Obestatin、AVP显著低于死亡组(均P<0.05),而GFR显著高于死亡组(P<0.05)。多元Logistic回归分析显示,血浆Obestatin、AVP为随访12月ESRD患者生存相关的危险因素(OR=3.219, P=0.011、OR=2.872, P=0.020)。ROC曲线显示,血浆Obestatin截断值为380.5 pg/ml,预测ESRD患者随访12月预后不良的AUC为0.849,敏感度为87.4%,特异度为79.2%。而AVP截断值为65.4 pg/ml,预测的AUC为0.822,敏感度为86.3%,特异度为80.6%。两者联合预测的AUC为0.885,敏感度为91.0%,特异度为86.4%。结论：ESRD患者血浆Obestatin及AVP值显著增加,且两者联合评估短期预后结局的准确度较好,值得临床推广应用。 |
| 英文摘要: |
| Objective To analyze the clinical value of the plasma levels of Obestatin and arginine vasopressin (AVP) to the hemodialysis effect and prognosis in patients with end stage renal disease (ESRD). Methods The 90 patients with ESRD receiving the maintenance hemodialysis in our hospital were collected to observation group. The contemporaneous 50 examinee with normal renal function were selected as control group. The indexes of the plasma Obestatin and AVP, glomerular filtration rate (GFR), BNP, Scr, Alb, PTH of patients were compared between two groups. The correlations of Obestatin and AVP to GFR、SCr、BNP、Alb、PTH were confirmed by Pearson linear correlation analysis. Follow-up 12 months, all patients with ESRD were divided into two groups according to the patients’ prognosis, which were survival group (56 cases) and death group (34 cases). The indexes of Obestatin, AVP, GFR, SCr, BNP, Alb and PTH were compared between two groups. The risk factors of 12 months follow-up survival rate of patients with ESRD to the clinical indexes were confirmed by multivariate Logistic analysis. The diagnostic value of the plasma levels of Obestatin and AVP to the 12 months follow-up prognosis of the patients with ESTD were analyzed by receiver operating characteristic curves (ROC). Results Compared to control group, the plasma levels of Obestatin and AVP, SCr, BNP in observation group were higher (all P<0.05), and the levels of GFR, Alb and PTH in observation group were lower (all P<0.05). The negative correlations of Obestatin and AVP to GFR were confirmed by Pearson linear correlation analysis (P<0.05), and the positive correlations of Obestatin and AVP to SCr and BNP were also confirmed (P<0.05). The plasma levels of Obestatin and AVP in survival group were lower than death group (all P<0.05), and the GFR in survival group were higher than death group (P<0.05). Multivariate Logistic analysis showed that the plasma levels of Obestatin and AVP were independent risk factors to the 12 months follow-up survival rate of patients with ESRD (OR=3.219, P=0.011; OR=2.872, P=0.020). When the cut-off point of Obestatin level was 380.5 pg/ml, the AUC of predictions to the poor prognosis in patients with ESRD was 0.849 and the sensitivity was 87.4% and specificity was 79.2%. And when the cut-off point of AVP level was 65.4 pg/ml, the AUC was 0.822 and the sensitivity was 86.3% and specificity was 80.6%. When the RE combined with SE, the AUC was 0.885 and the sensitivity was 91.0% and specificity was 86.4%. Conclusion The entropy indexes are positive relationship to the degrees of ABI. And the RE combined with SE can assess the 6 month follow-up prognosis of patients with ABI. |
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