摘要
目的探究尿毒症血液透析患者血清甲状旁腺激素(PTH)、成纤维生长因子21(FGF⁃21)和血管内皮生长因子(VEGF)的表达及临床意义。方法选取2020年6月至2024年5月南京市中心医院收治的尿毒症血液透析患者302例为透析组。采取残余肾功能(RRF)指标的高低将尿毒症患者分为轻度116例、中度107例和重度组79例,并纳入同期健康体检者184例作为对照组,比较对照组和不同病情程度患者的血清PTH、FGF⁃21和VEGF水平。根据血液透析中是否出现不良临床状况将患者分为预后良好组219例及预后不良组83例,比较两组的PTH、FGF⁃21和VEGF水平。结果治疗前后尿毒症及对照组血清PTH、FGF⁃21和VEGF水平对比:重度组>中度组>轻度组>对照组,差异有统计学意义(P<0.05);预后良好组的PTH、FGF⁃21和VEGF水平均较预后不良组低,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,PTH、FGF⁃21和VEGF是影响尿毒症预后不良的独立风险因素(P<0.05);血清PTH、FGF⁃21、VEGF以及三者联合检测的ROC曲线面积分别为0.703、0.667、0.715及0.822(P<0.05)。结论尿毒症血液透析患者预后不良主要与较高的血清PTH、FGF⁃21和VEGF水平有关;血清PTH、FGF⁃21和VEGF水平能有效筛选尿毒症血液透析患者预后不良的高危人群。
Objective To examine the expression and classical correlates of plasma parathyroid hormone(PTH),fibroblast growth factor 21(FGF⁃21)and growth factor(VEGF)in uremic hemodialysis patients.Methods A total of 302 patients undergoing uremic hemodialysis at Nanjing Central Hospital between June 2020 and May 2024 were retrospectively classified as part of the dialysis group.The index of residual renal function(RRF)was used to categorize uremic patients into three groups:mild(116 cases),moderate(107 cases),and severe(79 cases).Additionally,184 cases from the same period of healthy medical checkups were selected and matched for age and sex.The serum concentrations of PTH,FGF⁃21,and VEGF were measured in both the study and control groups.The patients were classified into two groups based on the presence or absence of adverse clinical conditions during hemodialysis:a good prognosis group consisting of 219 cases and a poor prognosis group consisting of 83 cases.The levels of PTH,FGF⁃21,and VEGF were compared between the two groups.Results A comparative analysis of PTH,FGF⁃21,and VEGF levels in patients with varying degrees of uremia revealed a statistically significant difference(P<0.05)among the four groups before and after therapy:the severe group had the highest levels,followed by the intermediate group,the mild group,and the reference group.The severe group exhibited the highest levels,surpassing those of the moderate and mild groups.The levels of PTH,FGF⁃21,and VEGF were shown to be lower in the group with a favorable prognosis compared to the group with an unfavorable prognosis,with significant differences(P<0.05).A multifactorial logistic regression analysis revealed that PTH,FGF⁃21,and VEGF were revealed to be independent risk factors affecting the poor prognosis of uremia(P<0.05).The areas under the ROC curves for serum PTH,FGF⁃21,VEGF,and the combined assay of all three were 0.703,0.667,0.715,and 0.822,respectively(P<0.05).Conclusion A poor prognosis in uremic hemodialysis patients is mainly associated with elevated levels of serum PTH,FGF⁃21,and VEGF.These levels of serum PTH,FGF⁃21,and VEGF can effectively identify the high⁃risk group for poor prognosis in uremic hemodialysis patients.
作者
李扬茉
左雨
李杰
LI Yangmo;ZUO Yu;LI Jie(Nephrology Department,Nanjing Central Hospital,Nanjing,Jiangsu,China,210000;Science and Education,Nanjing Central Hospital,Nanjing,Jiangsu,China,210000)
出处
《分子诊断与治疗杂志》
2025年第1期128-131,136,共5页
Journal of Molecular Diagnostics and Therapy
基金
江苏省老年健康科研项目计划(LR2022010)。
