| 孔祥静,肖达平,徐静琳,韩颖敏.尿毒症血液透析患者血浆ADAMTS-13变化与动静脉内瘘血栓形成的关系[J].浙江中西医结合杂志,2021,31(7): |
| 尿毒症血液透析患者血浆ADAMTS-13变化与动静脉内瘘血栓形成的关系 |
| Relationship between plasma ADAMTS-13 and arteriovenous fistula thrombosis in uremic hemodialysis patients |
| 投稿时间：2020-10-31 修订日期：2020-12-13 |
| DOI： |
| 中文关键词: 尿毒症 维持性血液透析 血管性血友病因子裂解酶 自体动静脉内瘘 血栓 |
| 英文关键词:uremia maintenance hemodialysis von Willebrand factor-cleaving protease autogenous arteriovenous fistula thrombosis |
| 基金项目: |
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| 中文摘要: |
| 目的 探究尿毒症维持性血液透析(MHD)患者血浆血管性血友病因子裂解酶(ADAMTS13)水平变化与自体动静脉内瘘(AVF)血栓形成的关系。方法 选取2016年3月~2018年7月行MHD的尿毒症患者139例为研究对象,对患者进行24个月随访,根据患者是否发生AVF血栓将其分为非血栓组94例和血栓组45例。比较两组一般资料；利用酶联免疫吸附法(ELISA)测定血浆ADAMTS-13、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平；Pearson法分析AVF血栓形成患者血浆ADAMTS-13水平与TNF-α、IL-6的相关性；Logistic回归分析尿毒症MHD患者发生AVF血栓的影响因素；采用受试者工作特征曲线(ROC)评价血浆ADAMTS-13水平对尿毒症MHD患者AVF血栓形成的预测价值。结果 血栓组低密度脂蛋白胆固醇、血浆TNF-α、IL-6水平均明显高于非血栓组(P<0.05),血浆ADAMTS-13水平明显低于非血栓组(P<0.05)；AVF血栓形成患者血浆ADAMTS-13水平与TNF-α、IL-6均呈负相关(P<0.05)；ADAMTS-13是影响尿毒症MHD患者发生AVF血栓的保护因素(P＜0.05),TNF-α、IL-6是影响尿毒症MHD患者发生AVF血栓的危险因素(P＜0.05)；血浆ADAMTS-13水平预测尿毒症MHD患者AVF血栓形成的曲线下面积(AUC)为0.888,截断值为170.98 mg/L,其灵敏度、特异度分别为84.4%、80.9%,诊断效能高于TNF-α、IL-6。结论 发生AVF血栓的尿毒症MHD患者血浆ADAMTS-13水平降低,其可能与TNF-α、IL-6相互影响,进而在AVF血栓形成过程中起重要作用,检测血浆ADAMTS-13水平有助于临床判定是否发生AVF血栓。 |
| 英文摘要: |
| Objective To explore the relationship between the changes of plasma levels of von Willebrand factor-cleaving protease (ADAMTS13) and thrombosis of autogenous arteriovenous fistula (AVF) in uremic patients undergoing maintenance hemodialysis (MHD). Methods A total of 139 uremic patients who underwent MHD from March 2016 to July 2018 were selected as the research objects. The patients were followed up for 24 months. According to whether AVF thrombosis occurred, the patients were divided into non thrombus group (94 cases) and thrombus group (45 cases). The general data of the two groups were compared; the levels of ADAMTS-13, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in plasma were measured by enzyme-linked immunosorbent assay (ELISA); Pearson method was used to analyze the correlation between plasma ADAMTS-13 level and TNF-α, IL-6 in patients with AVF thrombosis; Logistic regression analysis was used to analyze the influencing factors of AVF thrombosis in uremic MHD patients; receiver operating characteristic curve (ROC) was used to evaluate the predictive value of plasma ADAMTS-13 level for AVF thrombosis in uremic MHD patients. Results The levels of low-density lipoprotein cholesterol , plasma TNF-α and IL-6 in the thrombus group were significantly higher than those in the non thrombus group (P < 0.05), and the level of plasma ADAMTS-13 in the thrombus group was significantly lower than that in the non thrombus group (P < 0.05); the level of plasma ADAMTS-13 was negatively correlated with TNF-α and IL-6 in patients with AVF thrombosis (P < 0.05); ADAMTS-13 was the protective factor of AVF thrombosis in uremic MHD patients (P < 0.05), and TNF-α and IL-6 were the risk factors of AVF thrombosis in uremic MHD patients (P < 0.05); the area under the curve (AUC) of ADAMTS-13 in predicting AVF thrombosis in uremic MHD patients was 0.888 and the cut-off value was 170.98 mg/L. the sensitivity and specificity were 84.4% and 80.9% respectively, and the diagnostic efficiency of ADAMTS-13 was higher than that of TNF-α and IL-6. Conclusions The level of ADAMTS-13 in uremic MHD patients with AVF thrombosis is decreased, it may interact with TNF-α and IL-6, and play an important role in the process of AVF thrombosis. Detection of plasma ADAMTS-13 level is helpful for clinical judgment of AVF thrombosis. |
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