Diagnostic value of serum suPAR in the occurrence of arteriovenous fistula stenosis in maintenance hemodialysis patients

doi:10.3877/cma.j.issn.2095-3216.2024.02.003

Abstract

Abstract:

Objective

To explore the relationship between serum soluble urokinase-type plasminogen activator receptor (suPAR) level and arteriovenous fistula (AVF) stenosis in patients with maintenance hemodialysis (MHD).

Methods

A total of 115 patients, who underwent MHD treatment with AVF in our hospital from June 2018 to October 2020, were selected as the research objects. According to whether the patients had AVF stenosis, they were divided into AVF stenosis group (51 cases) and AVF non-stenosis group (64 cases). General data and laboratory indicators were collected. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum suPAR level. The factors influencing suPAR level were analyzed by multiple linear regression method. The risk factors of AVF stenosis in MHD patients were analyzed by logistic regression method. The value of serum suPAR in the diagnosis of AVF stenosis in MHD patients was evaluated by receiver operating characteristic (ROC) curve method.

Results

Compared with the AVF non-stenosis group, the AVF stenosis group showed significantly higher levels of white blood cell count, red blood cell count, blood creatinine, albumin, procalcitonin (PCT), C-reactive protein, and suPAR (P<0.05), but had lower level of high-density lipoprotein cholesterol (P<0.05). Serum suPAR levels in the groups were positively correlated with the white blood cell count, albumin, procalcitonin, and C-reactive protein (P<0.05), and negatively correlated with the high-density lipoprotein cholesterol (P<0.05). Multiple linear regression analysis showed that the white blood cell count, high density lipoprotein cholesterol, albumin, procalcitonin, and C-reactive protein were influencing factors of suPAR level (P<0.05). Logistic regression analysis showed that white blood cell count (OR=1.685, 95%CI: 1.024-2.772), PCT (OR=2.059, 95%CI: 1.108-3.825), C-reactive protein (OR=2.316, 95%CI: 1.225-4.380), and suPAR (OR=3.046, 95%CI: 1.583-5.862) were all associated with AVF stenosis in the MHD patients (P<0.05). To evaluate the diagnostic value of serum suPAR for AVF stenosis in the MHD patients, the area under the curve was 0.943 (95%CI: 0.883-0.977), and the cutoff value was 2.59 μg/L with a sensitivity of 90.7% and a specificity of 90.2%.

Conclusion

Serum suPAR might be of value for clinical diagnosis of AVF stenosis in MHD patients.

Key words: Maintenance hemodialysis, Soluble urokinase-type plasminogen activator receptor, Arteriovenous fistula stenosis

Quanxing Tang, Chang Zhou. Diagnostic value of serum suPAR in the occurrence of arteriovenous fistula stenosis in maintenance hemodialysis patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(02): 74-78.

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References 24

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项目	AVF非狭窄组(n＝64)	AVF狭窄组(n＝51)	t/χ²值	P值
年龄(岁)	54.25±11.16	53.04±10.85	0.591	0.556
男/女(例)	39/25	29/22	0.195	0.659
透析龄(月)	42.56±10.63	43.84±12.52	0.593	0.555
原发病[例(%)]			1.353	0.717
慢性肾小球肾炎	19(29.69)	11(21.57)	2.543	0.012
糖尿病肾病	7(10.94)	8(15.69)	4.436	<0.001
高血压肾损伤	18(28.13)	14(27.45)	1.409	0.161
慢性间质性肾炎	20(31.25)	18(35.29)	3.834	<0.001
白细胞计数(10⁹/L)	6.04±1.92	6.98±2.03	2.543	0.012
红细胞计数(10⁹/L)	2.86±0.73	3.51±0.84	4.436	<0.001
血糖(mmol/L)	5.14±1.35	5.59±2.06	1.409	0.161
血肌酐(μmol/L)	753.29±312.82	998.94±374.13	3.834	<0.001
高密度脂蛋白胆固醇(mmol/L)	1.24±0.41	0.98±0.30	3.790	<0.001
低密度脂蛋白胆固醇(mmol/L)	2.52±0.76	2.46±0.65	0.448	0.655
白蛋白(g/L)	33.74±5.12	37.86±5.67	4.087	<0.001
甘油三酯(mmol/L)	1.37±0.49	1.48±0.58	1.102	0.273
总胆固醇(mmol/L)	3.89±1.14	3.73±1.03	0.780	0.437
降钙素原(μg/L)	0.19±0.06	0.30±0.12	6.402	<0.001
C反应蛋白(mmol/L)	3.46±1.48	5.46±1.67	6.800	<0.001
suPAR(μg/L)	2.15±0.32	2.96±0.41	11.901	<0.001

项目	AVF非狭窄组(n＝64)	AVF狭窄组(n＝51)	t/χ²值	P值
年龄(岁)	54.25±11.16	53.04±10.85	0.591	0.556
男/女(例)	39/25	29/22	0.195	0.659
透析龄(月)	42.56±10.63	43.84±12.52	0.593	0.555
原发病[例(%)]			1.353	0.717
慢性肾小球肾炎	19(29.69)	11(21.57)	2.543	0.012
糖尿病肾病	7(10.94)	8(15.69)	4.436	<0.001
高血压肾损伤	18(28.13)	14(27.45)	1.409	0.161
慢性间质性肾炎	20(31.25)	18(35.29)	3.834	<0.001
白细胞计数(10⁹/L)	6.04±1.92	6.98±2.03	2.543	0.012
红细胞计数(10⁹/L)	2.86±0.73	3.51±0.84	4.436	<0.001
血糖(mmol/L)	5.14±1.35	5.59±2.06	1.409	0.161
血肌酐(μmol/L)	753.29±312.82	998.94±374.13	3.834	<0.001
高密度脂蛋白胆固醇(mmol/L)	1.24±0.41	0.98±0.30	3.790	<0.001
低密度脂蛋白胆固醇(mmol/L)	2.52±0.76	2.46±0.65	0.448	0.655
白蛋白(g/L)	33.74±5.12	37.86±5.67	4.087	<0.001
甘油三酯(mmol/L)	1.37±0.49	1.48±0.58	1.102	0.273
总胆固醇(mmol/L)	3.89±1.14	3.73±1.03	0.780	0.437
降钙素原(μg/L)	0.19±0.06	0.30±0.12	6.402	<0.001
C反应蛋白(mmol/L)	3.46±1.48	5.46±1.67	6.800	<0.001
suPAR(μg/L)	2.15±0.32	2.96±0.41	11.901	<0.001

血生化指标	AVF非狭窄组		AVF狭窄组
血生化指标	r值	P值	r值	P值
白细胞计数	0.324	0.002	0.339	<0.001
红细胞计数	0.298	0.054	0.342	0.052
血肌酐	0.241	0.054	0.296	0.051
高密度脂蛋白胆固醇	－0.343	<0.001	－0.415	<0.001
白蛋白	0.354	0.014	0.368	<0.001
降钙素原	0.326	0.001	0.403	<0.001
C反应蛋白	0.351	0.010	0.416	<0.001

血生化指标	AVF非狭窄组		AVF狭窄组
血生化指标	r值	P值	r值	P值
白细胞计数	0.324	0.002	0.339	<0.001
红细胞计数	0.298	0.054	0.342	0.052
血肌酐	0.241	0.054	0.296	0.051
高密度脂蛋白胆固醇	－0.343	<0.001	－0.415	<0.001
白蛋白	0.354	0.014	0.368	<0.001
降钙素原	0.326	0.001	0.403	<0.001
C反应蛋白	0.351	0.010	0.416	<0.001

自变量	β值	标准误	β′值	t值	P值
白细胞计数	0.954	0.273	0.168	3.495	<0.001
高密度脂蛋白胆固醇	－0.114	0.026	－0.216	－4.385	<0.001
白蛋白	0.268	0.104	0.126	2.577	0.010
降钙素原	0.212	0.060	0.479	3.560	0.001
C反应蛋白	0.352	0.161	0.294	2.190	0.035

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