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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 (02) : 61 -67. doi: 10.3877/cma.j.issn.2095-3216.2024.02.001

论著

平均血小板体积和平均血小板体积/血小板计数比值对血液透析患者血管通路失功的潜在预测价值
马丽洁1, 赵素梅1, 孙芳1, 孙倩美1,†()   
  1. 1. 100020　首都医科大学附属北京朝阳医院肾内科
  • 收稿日期:2022-11-10 出版日期:2024-04-28
  • 通信作者: 孙倩美

Potential predictive value of mean platelet volume and ratio of mean platelet volume to platelet count in vascular access failure of hemodialysis patients

Lijie Ma1, Sumei Zhao1, Fang Sun1, Qianmei Sun1,†()   

  1. 1. Department of Nephrology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China
  • Received:2022-11-10 Published:2024-04-28
  • Corresponding author: Qianmei Sun
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引用本文：

马丽洁, 赵素梅, 孙芳, 孙倩美. 平均血小板体积和平均血小板体积/血小板计数比值对血液透析患者血管通路失功的潜在预测价值[J]. 中华肾病研究电子杂志, 2024, 13(02): 61-67.

Lijie Ma, Sumei Zhao, Fang Sun, Qianmei Sun. Potential predictive value of mean platelet volume and ratio of mean platelet volume to platelet count in vascular access failure of hemodialysis patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(02): 61-67.

目的

探讨平均血小板体积(MPV)和平均血小板体积/血小板计数比值(MPV/PLT)与血液透析患者血管通路失功(VAF)的相关性，评估MPV和MPV/PLT对VAF的潜在预测价值。

方法

本研究为单中心回顾性研究。选取2015年1月至2021年6月北京朝阳医院肾内科血液净化中心以自体动静脉内瘘(AVF)为血管通路的维持性血液透析患者为研究对象，以是否发生血管通路功能障碍分为血管通路失功(VAF)组和非血管通路失功(非VAF)组。应用混合线性模型比较两组的MPV和MPV/PLT变化差异，Kaplan-Meier曲线比较不同MPV及MPV/PLT水平的VAF发生率，多因素Cox回归模型分析VAF发生的独立危险因素，以受试者工作特征(ROC)曲线评估MPV、MPV/PLT对血液透析患者VAF的预测价值。

结果

本研究共纳入307例MHD患者，其中VAF组99例、非VAF组208例。VAF组患者MPV、MPV/PLT、总胆固醇、尿酸、透析龄均较非VAF组高(P均<0.05)。混合线性模型比较发现，两组MPV无显著差异，而VAF组的MPV/PLT随着随访时间延长则显著高于非VAF组(P<0.001)。Kaplan-Meier曲线显示在不同MPV和MPV/PLT水平，VAF发生率的差异均有统计学意义(χ2＝30.580，P<0.001和χ2＝9.599，P＝0.008)。MPV、MPV/PLT水平越高，VAF发生率越高。矫正总胆固醇、尿酸、透析龄后，多因素Cox回归模型分析显示MPV(HR＝1.97，95%CI：1.60～2.42，P<0.001)、MPV/PLT(HR＝1.59，95%CI：1.32～1.92，P<0.001)是VAF发生的独立危险因素。MPV和MPV/PLT的ROC曲线下面积(AUC)分别为0.713和0.643，两者联合预测的AUC为0.716。

结论

维持性血液透析患者MPV和MPV/PLT增高与VAF发生相关，对VAF事件发生具有潜在的预测价值。

关键词: 血管通路失功, 血液透析, 平均血小板体积, 平均血小板体积/血小板计数比值
Objective

To investigate the correlation of mean platelet volume (MPV) and MPV to platelet count ratio MPV/PLT with vascular access failure (VAF) in maintenance hemodialysis (MHD) patients, and to evaluate the predictive value of MPV and MPV/PLT for VAF events.

Methods

This study was a single center retrospective study. MHD patients with autologous arteriovenous fistula (AVF) as the vascular access at the Renal Blood Purification Center of Beijing Chaoyang Hospital from January 2015 to June 2021 were selected. The study subjects were divided into two groups based on the occurrence of vascular dysfunction: VAF group and non-VAF group. The differences in MPV and MPV/PLT changes between the two groups were compared with the mixed linear model. Kaplan Meier curve was used to compare the VAF incidence at different levels of MPV and MPV/PLT. The multivariate Cox regression model was applied to analyze independent risk factors for VAF events. The receiver operating characteristic (ROC) curve was used to evaluate the value of MPV and MPV/PLT in predicting VAF events in the hemodialysis patients.

Results

This study included 307 MHD patients, with 99 in the VAF group and 208 in the non-VAF group. The MPV, MPV/PLT, total cholesterol, uric acid, and dialysis age of the VAF group were higher than those of the non-VAF group (P<0.05). The mixed linear model comparison showed that there was no significant difference in MPV between the two groups, while MPV/PLT of the VAF group was significantly higher than that of the non-VAF group with the follow-up time prolonging (P<0.001). The Kaplan Meier curve showed statistically significant differences in the incidence of VAF at different levels of MPV and MPV/PLT(χ2=30.580, P<0.001 and χ2=9.599, P=0.008). The higher the levels of MPV and MPV/PLT, the higher the incidence of VAF events. After correction for the total cholesterol, uric acid, and dialysis age, multivariate Cox regression model analysis showed that MPV (HR=1.97, 95%CI: 1.60-2.42, P<0.001) and MPV/PLT (HR=1.59, 95%CI: 1.32-1.92, P<0.001) were independent risk factors for the occurrence of VAF. The area under the ROC curve (AUC) were 0.713 and 0.643, respectively, while the AUC of the combination of them was 0.716.

Conclusions

Elevated levels of MPV and MPV/PLT in the MHD patients were associated with the occurrence of VAF, and might have potential predictive value.

Key words: Vascular access failure, Hemodialysis, Mean platelet volume, Ratio of mean platelet volume to platelet count
表1 两组患者基线临床资料的比较
  非VAF组(n＝208) VAF组(n＝99) t/Z/χ2值 P值
性别(男/女) 122/86 53/46 0.717c 0.397
年龄(岁) 58.2±12.6 59.1±13.5 0.549a 0.583
透析龄 76 (58，121) 94.5(58，171) 6.315b 0.012
血红蛋白(g/L) 110.2±9.4 110.1±9.9 0.011a 0.992
血清白蛋白(g/L) 38.0±4.9 37.4±5.5 0.888a 0.375
总胆固醇(mmol/L) 3.9±1.0 4.2±1.1 2.448a 0.015
高密度脂蛋白胆固醇(mmol/L) 1.1±0.4 1.1±0.5 0.278a 0.781
低密度脂蛋白胆固醇(mmol/L) 2.3±0.8 2.1±0.7 1.657a 0.099
甘油三酯(mmol/L) 1.6(1.0，2.4) 1.4(1.0，2.1) 1.982b 0.160
透析前血清肌酐(μmol/L) 854.2±295.6 868.7±290.6 0.405a 0.686
透析前尿素氮(mmol/L) 24.7±8.9 23.3±7.3 1.520a 0.130
透析前尿酸(mmol/L) 381.4±90.9 410.0±104.9 2.324a 0.021
透析前校正血清钙(mmol/L) 2.2±0.3 2.2±0.2 0.232a 0.817
透析前血清磷(mmol/L) 1.9(1.5，2.3) 1.7(1.5，2.2) 1.343b 0.247
空腹血糖(mmol/L) 5.6(4.6，7.3) 6.4(4.8，8.6) 2.542b 0.111
血清铁蛋白(μg/L) 185.0(95.1，357.2) 211.3(100.0，341.3) 0.426b 0.514
全段甲状旁腺激素(ng/L) 268.0(156.5，406.5) 235.0(143.0，455.5) 0.250b 0.617
C反应蛋白(mg/L) 1.8(1.1，3.0) 1.8(1.1，3.0) 0.178b 0.673
吸烟(是/否) 12/196 10/89 1.892c 0.169
合并糖尿病(有/无) 24/184 15/84 0.790c 0.374
合并高血压(有/无) 39/169 22/77 0.508c 0.476
MPV(fl) 10.1±0.8 10.8±1.0 6.199a <0.001
MPV/PLT 0.055±0.019 0.068±0.027 4.609a <0.001
图1 混合线性模型比较两组平均血小板体积随时间的变化注：MPV：平均血小板体积；VAF：血管通路失功
图2 混合线性模型比较两组平均血小板体积/血小板计数比值随时间的变化注：MPV/PLT：平均血小板体积/血小板计数比值；VAF：血管通路失功
图3 不同平均血小板体积组血液透析患者血管通路失功事件发生率比较(Kaplan-Meier曲线)注：VAF：血管通路失功；MPV：平均血小板体积
图4 不同平均血小板体积/血小板计数比值组血液透析患者血管通路失功事件发生率比较(Kaplan-Meier曲线)注：VAF：血管通路失功；MPV/PLT：平均血小板体积/血小板计数比值
表2 血液透析患者血管通路失功事件的单因素Cox回归模型分析
变量 HR(95%CI) P值
MPV 1.98(1.62～2.43) <0.001
MPV/PLT 1.66(1.38～1.99) <0.001
年龄 1.00(0.99～1.02) 0.545
性别 1.05(0.92～1.08) 0.625
血红蛋白 1.00(0.98～1.02) 0.811
血清白蛋白 0.99(0.95～1.02) 0.450
总胆固醇 1.25 (1.06～1.41) 0.008
高密度脂蛋白胆固醇 0.92(0.54～1.58) 0.761
低密度脂蛋白胆固醇 0.76(0.57～1.00) 0.052
甘油三酯 0.89(0.76～1.05) 0.185
血肌酐 1.00(1.00～1.00) 0.678
尿素 0.98(0.96～1.01) 0.175
尿酸 1.03(0.92～1.05) 0.014
血清校正钙 1.11(0.53～2.36) 0.779
血清磷 1.00(0.71～1.41) 0.988
空腹血糖 1.05(0.99～1.12) 0.087
血清铁蛋白 1.00(1.00～1.00) 0.914
全段甲状旁腺激素 1.00(1.00～1.00) 0.978
C反应蛋白 0.94(0.85～1.03) 0.189
透析龄 1.23(1.03～1.47) 0.019
吸烟 1.60(0.83～3.08) 0.158
糖尿病 1.31(0.76～2.27) 0.338
高血压 1.17(0.78～1.97) 0.525
表3 平均血小板体积、平均血小板体积/血小板计数比值在血液透析患者血管通路失功事件多因素Cox回归的校正模型
变量 HR(95%CI) P值
MPV 1.97(1.60～2.42) <0.001
MPV/PLT 1.59 (1.32～1.92) <0.001
图5 平均血小板体积、平均血小板体积/血小板计数比值单独及联合模型对血液透析患者血管通路失功事件预测ROC曲线注：MPV：平均血小板体积；MPV/PLT：平均血小板体积/血小板计数比值
[1]
周敏，卢方平. 维持性血液透析患者后期自体动静脉内瘘功能不良/失功修复术后通畅率观察[J]. 中华医学杂志，2017, 97(15): 1175-1178.
[2]
钟小燕，杨枫，钟晓容，等. CD62P、CD63、平均血小板体积与动静脉内瘘血栓形成的关系研究[J]. 中外医疗，2021, 40(29): 31-34.
[3]
Feldman HI, Kobrin S, Wasserstein A. Hemodialysis vascular access morbidity [J]. J Am Soc Nephrol, 1996, 7(4): 523-535.
[4]
Woods JD, Port FK. The impact of vascular access for haemodialysis on patient morbidity and mortality [J]. Nephrol Dial Transplant, 1997, 12(4): 657-659.
[5]
Faure V, Dou L, Sabatier F, et al. Elevation of circulating endothelial microparticles in patients with chronic renal failure [J]. J Thromb Haemost, 2006, 4(3): 566-573.
[6]
Sallée M, Dou L, Cerini C, et al. The aryl hydrocarbon receptor-activating effect of uremic toxins from tryptophan metabolism: a new concept to understand cardiovascular complications of chronic kidney disease [J]. Toxins, 2014, 6(3): 934-949.
[7]
Norgaz T, Hobikoglu G, Aksu H, et al. The relationship between preprocedural platelet size and subsequent in-stent restenosis [J]. Acta Cardiol, 2004, 59(4): 391-395.
[8]
Yang A, Pizzulli L, Luderitz B. Mean platelet volume as marker of restenosis after percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris [J]. Thromb Res, 2006, 117(4): 371-377.
[9]
Azab B, Torbey E, Singh J, et al. Mean plateletvolume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction [J]. Platelets, 2011, 22(8): 557-566.
[10]
金其庄，王玉柱，叶朝阳，等. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化，2019, 18(6): 365-381.
[11]
Churchill DN, Taylor DW, Cook RJ, et al. Canadian hemodialysis morbidity study [J]. Am J Kidney Dis, 1992, 19(3): 214-234.
[12]
Shin DH, Rhee SY, Jeon HJ, et al. An increase in mean platelet volume/platelet count ratio is associated with vascular access failure in hemodialysis patients [J]. PLoS One, 2017, 12(1): e0170357.
[13]
Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access [J]. J Vasc Surg, 2012, 55(3): 849-855.
[14]
Gagliardi GM, Rossi S, Condino F, et al. Malnutrition, infection and arteriovenous fistula failure: is there a link? [J]. J Vasc Access, 2011, 12(1): 57-62.
[15]
Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint [J]. J Am Soc Nephrol, 2006, 17(4): 1112-1127.
[16]
Jackson SR, Carter JM. Platelet volume: laboratory measurement and clinical application [J]. Blood Rev, 1993, 7(2): 104-113.
[17]
Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis [J]. J Thromb Haemost, 2010, 8(1): 148-156.
[18]
Choi CU, Seo HS, Kim YK, et al. Can mean platelet volume predict coronary vasospasm? [J]. Platelets, 2011, 22(3): 173-178.
[19]
Berger JS, Eraso LH, Xie D, et al. Mean platelet volume and prevalence of peripheral artery disease, the national health and nutrition examination survey, 1999-2004 [J]. Atherosclerosis, 2010, 213(2): 586-591.
[20]
Troussard X, Vol S, Cornet E, et al. Full blood count normal reference values for adults in France [J]. J Clin Pathol, 2014, 67(4): 341-344.
[21]
Lano G, Sallée M, Pelletier M, et al. Mean platelet volume predicts vascular access events in hemodialysis patients [J]. J Clin Med, 2019, 8(5): 608.
[22]
Anderson J, Abbuhl M, Hering T, et al. Immunohistochemical identification of components in the healing response of human vascular grafts [J]. ASAIO J, 1985, 8(3): 79-85.
[23]
Bigalke B, Stellos K, Stakos D, et al. Influence of platelet count on the expression of platelet collagen receptor glycoprotein VI (GPVI) in patients with acute coronary syndrome [J]. Thromb Haemost, 2009, 101(5): 911-915.
[24]
Jaremo P, Hansson G, Nilsson O. Elevated inflammatory parameters are associated with lower platelet density in acute myocardial infarctions with ST-elevation [J]. Thromb Res, 2000, 100(6): 471-478.
[25]
Han JS, Park TS, Cho SY, et al. Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis [J]. Platelets, 2013, 24(8): 590-593.
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