摘要
目的探讨维持性血液透析(MHD)患者经腔内血管成形术(PTA)后对血清生物标志物和肺动脉压(PAP)的影响。方法选取2019年9月至2021年3月在湖南省人民医院收治的50例患有动静脉内瘘(AVF)闭塞的MHD患者作为研究对象,分为PTA组37例,中心静脉导管(CVC)组13例。收集所有患者的一般资料,对比两组患者手术前后的结果,并分析各指标与PAP的相关性。采用Logistic回归分析,探讨肺动脉高压(PH)的独立危险因素。通过受试者工作特征(ROC)曲线分析血红蛋白和C反应蛋白预测PTA组发生PH的价值。结果PTA组术后24 h与术前比较,PAP和内皮素-1(ET-1)水平明显升高,而一氧化氮(NO)水平明显降低(P<0.05)。Spearman相关分析显示,PTA组的PAP与MHD时间、血磷、C反应蛋白、ET-1水平呈正相关(r=0.541、0.547、0.622、0.589,P<0.05),而与血红蛋白、NO水平呈负相关(r=-0.684、-0.633,P<0.05)。Logistic回归分析显示,血红蛋白降低、C反应蛋白升高是PTA组患者发生PH的独立危险因素(P<0.05)。ROC曲线分析显示,血红蛋白和C反应蛋白二者联合检测对预测PTA组发生PH的AUC大于二者单项检测。结论MHD患者PTA术后PAP升高,C反应蛋白水平升高和血红蛋白水平降低是PTA术后MHD患者发生PH的独立危险因素。
Objective To explore the effect of maintenance hemodialysis(MHD)on serum biomarkers and pulmonary arterial pressure(PAP)in patients with chronic kidney disease after percutaneous transluminal angioplasty(PTA).Methods A total of 50 cases of MHD with arteriovenous fistula(AVF)occlusion who were admitted to Hunan Provincial People′s Hospital from September 2019 to March 2021 were selected as the research objects,and were divided into two groups,PTA group(37 cases)and central venous catheter(CVC)group(13 cases).General data of all patients were collected,and the results of the two groups before and after surgery were compared,and the correlation between each index and PAP was analyzed.Logistic regression analysis was used to investigate the independent risk factors of pulmonary hypertension(PH)in PTA group.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of hemoglobin and C-reactive protein on the occurrance of PH in PTA group.Results Compared with before surgery,PAP and ET-1 levels were significantly increased,while NO level was significantly decreased in PTA group 24 hours after surgery(P<0.05).Spearman correlation analysis showed that PAP in PTA group was positively correlated with MHD time,blood phosphorus,C-reactive protein and ET-1 levels(r=0.541,0.547,0.622,0.589,P<0.05),while it was negatively correlated with hemoglobin and NO levels(r=-0.684,-0.633,P<0.05).Logistic regression analysis showed that decreased hemoglobin and increased C-reactive protein levels were independent risk factors for PH in PTA group(P<0.05).ROC curve analysis showed that the AUC of combined detection of hemoglobin and C-reactive protein in predicting the occurrance of PH in PTA group was greater than that of single detection of hemoglobin and C-reactive protein.Conclusion The PAP of MHD patients increases after PTA.The increase of C-reactive protein level and the decrease of hemoglobin level are independent risk factors for PH in MHD patients after PTA.
作者
陈娟
刘伊芳
施文剑
陈钰
欧阳沙西
CHEN Juan;LIU Yifang;SHI Wenjian;CHEN Yu;OUYANG Shaxi(Department of Nephrology,the First Affiliated Hospital of Hunan Normal University/Hunan Provincial People′s Hospital,Changsha,Hunan 410000,China)
出处
《国际检验医学杂志》
CAS
2022年第2期208-212,216,共6页
International Journal of Laboratory Medicine
关键词
慢性肾脏病
经腔内血管成形术
内皮素-1
一氧化氮
肺动脉高压
chronic kidney disease
percutaneous transluminal angioplasty
endothelin-1
nitric oxide
pulmonary arterial hypertension
