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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2022, Vol. 11 ›› Issue (03) : 139 -144. doi: 10.3877/cma.j.issn.2095-3216.2022.03.004

论著

血浆过氧化物还原酶2与维持性血液透析患者预后的相关性研究
杨文1,†(), 韩宝华2, 韩树池2, 王慧2   
  1. 1. 075000　张家口，河北北方学院附属第一医院血液净化科
    2. 075000　张家口，河北北方学院附属第一医院急诊重症医学科
  • 收稿日期:2021-07-28 出版日期:2022-06-28
  • 通信作者: 杨文
  • 基金资助:
    河北省医学科学研究课题计划(20211693)

Correlation of plasma peroxiredoxin 2 with prognosis in maintenance hemodialysis patients

Wen Yang1,†(), Baohua Han2, Shuchi Han2, Hui Wang2   

  1. 1. Department of Blood Purification; First Hospital Affiliated to Hebei North University, Zhangjiakou 075000, Hebei Province, China
    2. Department of Emergency Intensive Care Unit; First Hospital Affiliated to Hebei North University, Zhangjiakou 075000, Hebei Province, China
  • Received:2021-07-28 Published:2022-06-28
  • Corresponding author: Wen Yang
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杨文, 韩宝华, 韩树池, 王慧. 血浆过氧化物还原酶2与维持性血液透析患者预后的相关性研究[J/OL]. 中华肾病研究电子杂志, 2022, 11(03): 139-144.

Wen Yang, Baohua Han, Shuchi Han, Hui Wang. Correlation of plasma peroxiredoxin 2 with prognosis in maintenance hemodialysis patients[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2022, 11(03): 139-144.

目的

探究血浆过氧化物还原酶2(PRDX2)与维持性血液透析(MHD)患者预后的相关性。

方法

选取2018年3月至6月于河北北方学院附属第一医院就诊的134例MHD患者(MHD组)和100例健康体检者(对照组)；根据随访期间是否发生终点事件(主要不良心血管事件，MACE)，将MHD患者分为非MACE组和MACE组。用酶联免疫吸附法检测血浆PRDX2水平，用COX回归分析MHD患者发生MACE的风险因素，用受试者工作特征(ROC)曲线评价PRDX2预测MHD患者发生MACE的价值，用限制性立方样条拟合COX回归方法分析PRDX2与MHD患者发生MACE的剂量-效应关系。

结果

MHD组的血浆PRDX2水平低于对照组(P<0.05)。MACE组有糖尿病史比例和超敏C反应蛋白水平均高于非MACE组，血红蛋白和血浆白蛋白水平均低于非MACE组(P<0.05)。MACE组的治疗前和治疗后的血浆PRDX2水平均低于非MACE组；MACE组和非MACE组的治疗后血浆PRDX2水平均较治疗前升高；MACE组治疗后的血浆PRDX2水平升高程度高于非MACE组(均P<0.05)。治疗前PRDX2预测MHD患者发生MACE的ROC曲线下面积大于治疗后面积和治疗前后面积的差值(P<0.05)。COX回归分析结果显示高血红蛋白(HR＝0.975，95%CI：0.959~0.992，P＝0.004)、高血浆白蛋白(HR＝0.928，95%CI：0.888~0.971，P＝0.001)和治疗前的高PRDX2水平(HR＝0.827，95%CI：0.743~0.920，P<0.001)是MHD患者发生MACE的独立保护因素。限制性立方样条拟合COX回归分析显示，治疗前PRDX2水平与MHD患者发生MACE呈非线性关系。

结论

治疗前的血浆PRDX2水平与MHD患者发生MACE有关，其水平低提示MHD患者发生MACE风险高。

关键词: 血浆, 过氧化物还原酶2, 维持性血液透析, 预后
Objective

To explore the correlation between peroxiredoxin 2 (PRDX2) and the prognosis of patients treated by maintenance hemodialysis (MHD).

Methods

A total of 134 patients treated by MHD (MHD group) and 100 healthy subjects (control group) were selected from the First Hospital Affiliated to Hebei North University from March to June 2018. The patients treated by MHD were divided into non-MACE group and MACE group according to the occurrence of endpoint events (major adverse cardiovascular events, MACE) during the follow-up period. Plasma PRDX2 level was detected by enzyme-linked immunosorbent assay. COX regression method was used to analyze the risk factors for the occurrence of MACE in the patients treated by MHD. The receiver operating characteristic (ROC) curve was used to evaluate the value of PRDX2 in predicting the occurrence of MACE in MHD patients. The dose-effect relationship between PRDX2 and the occurrence of MACE in MHD patients was analyzed by the restrictive cubic spline fitting COX regression method.

Results

The level of plasma PRDX2 in the MHD group was lower than that in the control group (P<0.05). In the MACE group, the proportion of diabetes history and the level of high-sensitivity C-reactive protein (hs-CRP) were higher than those in the non-MACE group, while the levels of hemoglobin and plasma albumin were lower than those in the non-MACE group (P<0.05). The levels of plasma PRDX2 before and after treatment in the MACE group were lower than those in the non-MACE group (P<0.05). The levels of plasma PRDX2 after treatment in both the MACE group and the non-MACE group were higher than those before treatment (P<0.05). The increase degree of plasma PRDX2 after treatment in the MACE group was higher than that in the non-MACE group (P<0.05). The area under the ROC curve of PRDX2 before treatment in predicting the occurrence of MACE in MHD patients was larger than both that after treatment and that of the difference value of those before and after treatment (P<0.05). COX regression analysis showed that high level of hemoglobin (HR=0.975, 95%CI: 0.959-0.992, P=0.004), high level of plasma albumin (HR=0.928, 95%CI: 0.888-0.971, P=0.001), and high level of pre-treatment PRDX2 (HR=0.827, 95%CI: 0.743-0.920, P<0.001) were independent protective factors for the occurrence of MACE in the MHD patients. The results of COX regression analysis with restricted cubic spline fitting showed that the level of PRDX2 before treatment had a non-linear relationship with the occurrence of MACE in the MHD patients.

Conclusion

The level of plasma PRDX2 before treatment related to the occurrence of MACE in the patients treated by MHD, whose lower level may indicate a high risk of MACE in the MHD patients.

Key words: Plasma, Peroxiredoxin 2, Maintenance hemodialysis, Prognosis
表1 MHD组和对照组的临床资料比较
项目 MHD组(n＝134) 对照组(n＝100) t/χ2值 P值
年龄(岁) 58.26±7.35 58.35±7.39 0.091 0.927
男性[例(%)] 72(53.73) 44(44.00) 2.169 0.141
BMI(kg/m2) 24.22±2.63 24.11±2.84 0.294 0.769
高血压史[例(%)] 108(80.60) 85(85.00) 0.768 0.381
糖尿病史[例(%)] 33(24.63) 15(15.00) 3.255 0.071
PRDX2(ng/ml) 10.64±2.63 20.48±3.11 26.207 <0.001
表2 两组临床资料比较
项目 MACE组(n＝77) 非MACE组(n＝57) t/χ2值 P值
年龄(岁) 58.83±6.80 57.49±8.03 1.044 0.298
男性[例(%)] 45(58.44) 27(47.37) 1.615 0.204
BMI(kg/m2) 24.28±2.57 24.14±2.74 0.305 0.761
高血压史[例(%)] 61(79.22) 47(82.46) 0.219 0.640
糖尿病史[例(%)] 25(32.47) 8(14.04) 5.995 0.014
基础疾病类型[例(%)]     1.340 0.720
原发性肾小球肾炎 41(53.25) 32(56.14)    
  糖尿病肾病 11(14.29) 5(8.77)    
  高血压肾病 18(23.38) 16(28.07)    
  其他肾病 7(9.09) 4(7.02)    
血红蛋白(g/L) 81.78±12.47 100.21±12.43 8.473 <0.001
血浆白蛋白(g/L) 30.25±5.00 39.68±6.09 9.837 <0.001
hs-CRP(ng/L) 7.74±2.15 5.42±1.57 7.232 <0.001
表3 两组血浆过氧化物还原酶2水平比较(ng/ml, ±s)
　分组 例数 治疗前 治疗后 治疗前后差值a
MACE组 77 9.35±1.85 13.63±3.14 3.95(2.25，6.06)
非MACE组 57 12.38±2.52 15.68±2.06 2.27(1.11，5.20)
t/Z值   　7.679 　4.553 　2.223
P值   <0.001 <0.001 　0.026
图1 血浆过氧化物还原酶2判断维持性血液透析患者发生主要不良心血管事件的ROC曲线注：PRDX2：过氧化物还原酶2
表4 血浆过氧化物还原酶2判断维持性血液透析患者发生主要不良心血管事件的价值
指标 曲线下面积(95%CI) 最佳截断点(ng/ml) 灵敏度(%) 特异度(%)
治疗前 0.822(0.747~0.896) 11.82 93.51 59.65
治疗后 0.689(0.601~0.778) 14.70 63.64 70.18
治疗前后差值 0.613(0.515~0.710) 2.21 76.62 49.12
表5 维持性血液透析患者发生主要不良心血管事件的风险因素分析
变量 单因素 多因素
HR(95%CI) P值 HR(95%CI) P值
年龄(岁) 1.011(0.981~1.042) 0.480    
性别(1/0) 1.330(0.845~2.093) 0.218    
BMI(kg/m2) 1.004(0.923~1.092) 0.927    
高血压史(1/0) 0.806(0.465~1.397) 0.442    
糖尿病史(1/0) 1.918(1.187~3.099) 0.008 1.164(0.708~1.914) 0.551
基础疾病类型(3/2/1/0) 0.966(0.782~1.195) 0.752    
血红蛋白(g/L) 0.952(0.938~0.966) <0.001 0.975(0.959~0.992) 0.004
血浆白蛋白(g/L) 0.868(0.834~0.903) <0.001 0.928(0.888~0.971) 0.001
hs-CRP(ng/L) 1.335(1.207~1.475) <0.001 1.124(0.997~1.268) 0.056
治疗前PRDX2(ng/ml) 0.751(0.682~0.827) <0.001 0.827(0.743~0.920) <0.001
图2 治疗前血浆过氧化物还原酶2与维持性血液透析患者发生主要不良心血管事件的剂量-效应关系注：PRDX2：过氧化物还原酶2
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