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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2024, Vol. 13 ›› Issue (01) : 34 -38. doi: 10.3877/cma.j.issn.2095-3216.2024.01.005

论著

维持性血液透析患者血清热休克蛋白70及簇集蛋白水平与主要不良心血管事件的相关性
冯娟1,†(), 詹伟强2   
  1. 1. 644000　宜宾市第一人民医院肾病内科
    2. 644000　宜宾市第一人民医院急诊科
  • 收稿日期:2023-06-15 出版日期:2024-02-28
  • 通信作者: 冯娟

Relationship between major adverse cardiovascular events and serum levels of heat shock protein 70 and clusterin in patients undergoing maintenance hemodialysis

Juan Feng1,†(), Weiqiang Zhan2   

  1. 1. Department of Nephrology; Yibin First People′s Hospital, Yibin 644000, Sichuan Province, China
    2. Department of Emergency; Yibin First People′s Hospital, Yibin 644000, Sichuan Province, China
  • Received:2023-06-15 Published:2024-02-28
  • Corresponding author: Juan Feng
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冯娟, 詹伟强. 维持性血液透析患者血清热休克蛋白70及簇集蛋白水平与主要不良心血管事件的相关性[J]. 中华肾病研究电子杂志, 2024, 13(01): 34-38.

Juan Feng, Weiqiang Zhan. Relationship between major adverse cardiovascular events and serum levels of heat shock protein 70 and clusterin in patients undergoing maintenance hemodialysis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(01): 34-38.

目的

探讨血清热休克蛋白70(HSP-70)、簇集蛋白水平与维持性血液透析患者主要不良心血管事件(MACE)的相关性。

方法

选取183例接受维持性血液透析的终末期肾病患者为研究对象，记录患者基线资料，根据患者1年随访期间MACE发生情况分为MACE组57例和非MACE组126例。采用酶联免疫吸附法检测血清HSP-70、簇集蛋白水平；受试者工作特征(ROC)曲线方法分析血清HSP-70、簇集蛋白水平在评估MACE中的价值；多因素Logistic回归方法分析MACE的影响因素。

结果

MACE组的血清HSP-70、簇集蛋白、甘油三酯及甲状旁腺激素水平高于非MACE组(t＝7.763、8.550、4.156、4.908)，左室射血分数低于非MACE组(t＝10.931)，差异均有统计学意义(P<0.05)。血清HSP-70、簇集蛋白单独及联合评估MACE的曲线下面积分别为0.757、0.859、0.903。HSP-70和簇集蛋白是影响维持性血液透析终末期肾病患者MACE发生的独立影响因素(OR＝2.947、3.074，95%CI：1.549～5.605、1.691～5.589，P<0.05)。

结论

在并发MACE的维持性血液透析患者中，血清HSP-70和簇集蛋白水平升高，并是MACE发生的影响因素。临床上评估MACE事件发生的风险时，血清HSP-70和簇集蛋白水平可以作为参考指标。

关键词: 维持性血液透析, 主要不良心血管事件, 热休克蛋白70, 簇集蛋白
Objective

To investigate the relationship between major adverse cardiovascular events (MACE) and serum levels of heat shock protein 70 (HSP-70) and clusterin in patients undergoing maintenance hemodialysis.

Methods

A total of 183 end-stage renal disease patients undergoing maintenance hemodialysis were selected as the study subjects whose baseline data were recorded. And the patients were divided into the MACE group (57 cases) and the non-MACE group (126 cases) based on MACE during the one-year follow-up. Enzyme-linked immunosorbent assay (ELISA) was applied to measure the serum levels of HSP-70 and clusterin. Receiver operating characteristic (ROC) curve was applied to analyze the value of serum HSP-70 and clusterin in evaluating occurrence of MACE in the patients. Multivariate logistic regression method was used to analyze the affecting factors for occurrence of MACE in the patients.

Results

The serum levels of HSP-70, clusterin, triglyceride, and parathyroid hormone of the MACE group were higher than those of the non-MACE group (t=7.763, 8.550, 4.156, 4.908, respectively), while LVEF was lower than that of the non-MACE group (t=10.931) (P<0.05). The AUC of serum HSP-70, clusterin, and HSP-70 plus clusterin in evaluating MACE in the patients was 0.757, 0.859, and 0.903, respectively. HSP-70 and clusterin were independent affecting factors for MACE occurrence in the patients (OR=2.947, 3.074, respectively; 95%CI: 1.549-5.605, 1.691-5.589, respectively; P<0.05).

Conclusion

In maintenance hemodialysis patients complicated with MACE, elevated levels of serum HSP-70 and clusterin were influencing factors for the occurrence of MACE. When evaluating the risk of MACE occurrence in clinical practice, serum HSP-70 and clusterin might serve as reference indicators.

Key words: Maintenance hemodialysis, Major adverse cardiovascular events, Heat shock protein 70, Clusterin
表1 非主要不良心血管事件组与主要不良心血管事件组基线资料及血清热休克蛋白70、簇集蛋白水平比较
项目 非MACE组(n＝126) MACE组(n＝57) 统计值(t/χ2) P值
年龄(岁) 55.72±8.95 55.41±9.02 t＝0.216 0.829
男性[例(%)] 71(56.35) 33(57.89) χ2＝0.038 0.845
BMI(kg/m2) 22.42±3.15 22.45±3.36 t＝0.058 0.953
透析龄(月) 45.78±9.33 46.21±9.52 t＝0.287 0.775
收缩压(mmHg) 132.08±10.16 133.45±10.97 t＝0.824 0.411
舒张压(mmHg) 85.04±7.42 85.91±7.57 t＝0.730 0.466
吸烟史[例(%)] 67(53.17) 30(52.63) χ2＝0.005 0.946
饮酒史[例(%)] 25(19.84) 11(19.30) χ2＝0.007 0.932
原发病[例(%)]     χ2＝0.043 0.998
高血压肾病 48(38.10) 21(36.84)    
糖尿病肾病 35(27.78) 16(28.07)    
肾小球肾炎 33(26.19) 15(26.32)    
其他 10(7.94) 5(8.77)    
总胆固醇(mmol/L) 4.86±0.49 4.91±0.48 t＝0.643 0.521
三酰甘油(mmol/L) 1.72±0.32 1.95±0.40 t＝4.156 <0.001
LDL-C(mmol/L) 2.96±0.37 3.04±0.29 t＝1.443 0.151
HDL-C(mmol/L) 1.19±0.23 1.17±0.25 t＝0.530 0.597
血钙(mmol/L) 2.21±0.28 2.19±0.30 t＝0.438 0.662
血磷(mmol/L) 1.68±0.32 1.70±0.35 t＝0.380 0.704
Kt/V 1.27±0.23 1.26±0.24 t＝0.269 0.788
血肌酐(μmol/L) 682.51±55.93 692.34±50.66 t＝1.133 0.259
血尿素氮(mmol/L) 23.94±2.76 24.02±2.81 t＝0.181 0.857
pH 7.01±0.86 6.98±0.89 t＝0.216 0.829
PTH(ng/L) 291.35±50.11 330.14±48.16 t＝4.908 <0.001
LVEF(%) 59.51±6.46 48.09±6.73 t＝10.931 <0.001
LVEDD(mm) 52.46±6.86 53.08±6.94 t＝0.564 0.573
LVESD(mm) 36.75±7.71 37.12±7.96 t＝0.298 0.766
HSP-70(ng/ml) 22.73±4.87 30.26±8.15 t＝7.763 <0.001
簇集蛋白(μg/L) 118.42±20.35 148.66±25.74 t＝8.550 <0.001
图1 血清热休克蛋白70和簇集蛋白水平评估维持性血液透析终末期肾病患者发生主要不良心血管事件的受试者工作特征曲线
表2 血清热休克蛋白70和簇集蛋白水平单独及联合评估维持性血液透析终末期肾病患者发生主要不良心血管事件的价值
指标 AUC 95%CI 敏感度(%) 特异度(%) 截断值
热休克蛋白70 0.757 0.679～0.835 57.94 85.96 27.90 ng/ml
簇集蛋白 0.859 0.819～0.884 80.95 82.46 137.36 μg/L
联合 0.903 0.851～0.954 89.68 80.70 －
表3 影响维持性血液透析终末期肾病患者发生主要不良心血管事件的多因素Logistic回归分析
影响因素 B值 标准误 Wald χ2 OR值 95%CI P值
热休克蛋白70 1.081 0.328 10.858 2.947 1.549～5.605 0.001
簇集蛋白 1.123 0.305 13.556 3.074 1.691～5.589 <0.001
甘油三酯 0.103 0.101 1.031 1.108 0.909～1.351 0.310
甲状旁腺激素 0.111 0.147 0.566 1.117 0.837～1.490 0.452
左室射血分数 0.159 0.228 0.485 1.172 0.750～1.832 0.486
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