CAJ | 학술논문

目的通过检测血液透析(血透)患者血浆五聚素3(PTX3)水平和踝臂指数(ABI),探讨PTX3在血透患者外周动脉疾病(PAD)发生发展中的可能作用.方法选取接受规律性血透3个月以上患者.根据ABI将血透患者分为PAD组(ABI<0.9)和非PAD组(ABI≥0.9).收集血透患者临床资料、相关生化指标和炎性反应指标.选取体检健康人为对照组.用ELISA方法测定各组血浆PTX3水平.用Logistic回归方法分析PAD与PTX3及其它因素间的关系.结果本中心116例血透患者入选.PAD的发生率为18.1%(21/116).血透患者血浆PTX3水平显著高于对照组[(2.90+1.03)μg/L比(1.70±0.85)μg/L,P<0.01];PAD组血浆PTX3水平显著高于非PAD组[(5.55+2.63)μg/L比(2.32±1.29)μg/L,P<0.01].单变量分析显示ABI与PTX3水平(r=-0.548,P<0.01)、超敏C反应蛋白(hsCRP)水平(r=-0.495,P<0.01)均呈负相关.PAD的ROC曲线分析显示,PTX3曲线下面积为0.901(P<0.01),当以4.06μg/L为检测截点时,其敏感性和特异性分别为81.0%和91.5%;hsCRP曲线下面积为0.640(P<0.05),当检测的截点为3.33 mg/L时,其敏感性和特异性分别为57.1%和56.8%.Logistic回归分析显示,PTX3血浆浓度上升对PAD的优势比(OR)值为9.755(95%CI:2.359～19.354,P=0.001).结论本中心规律性血透患者PAD发生率为18.1%.血透患者血浆PTX3水平显著高于健康对照组.PAD与血浆PTX3水平升高相关.PTX3作为诊断PAD的参考指标,其特异性和敏感性均优于hsCRP.
목적 통과검측혈액투석(혈투)환자혈장오취소3(PTX3)수평화과비지수(ABI),탐토PTX3재혈투환자외주동맥질병(PAD)발생발전중적가능작용.방법 선취접수규률성혈투3개월이상환자.근거ABI장혈투환자분위PAD조(ABI<0.9)화비PAD조(ABI≥0.9).수집혈투환자림상자료、상관생화지표화염성반응지표.선취체검건강인위대조조.용ELISA방법측정각조혈장PTX3수평.용Logistic회귀방법분석PAD여PTX3급기타인소간적관계.결과 본중심116례혈투환자입선.PAD적발생솔위18.1%(21/116).혈투환자혈장PTX3수평현저고우대조조[(2.90+1.03)μg/L비(1.70±0.85)μg/L,P<0.01];PAD조혈장PTX3수평현저고우비PAD조[(5.55+2.63)μg/L비(2.32±1.29)μg/L,P<0.01].단변량분석현시ABI여PTX3수평(r=-0.548,P<0.01)、초민C반응단백(hsCRP)수평(r=-0.495,P<0.01)균정부상관.PAD적ROC곡선분석현시,PTX3곡선하면적위0.901(P<0.01),당이4.06μg/L위검측절점시,기민감성화특이성분별위81.0%화91.5%;hsCRP곡선하면적위0.640(P<0.05),당검측적절점위3.33 mg/L시,기민감성화특이성분별위57.1%화56.8%.Logistic회귀분석현시,PTX3혈장농도상승대PAD적우세비(OR)치위9.755(95%CI:2.359～19.354,P=0.001).결론 본중심규률성혈투환자PAD발생솔위18.1%.혈투환자혈장PTX3수평현저고우건강대조조.PAD여혈장PTX3수평승고상관.PTX3작위진단PAD적삼고지표,기특이성화민감성균우우hsCRP.
Objective To clarify the role of pentraxin 3 (PTX3) in the development of peripheral arterial disease (PAD) in maintenance hemodialysis (MHD) patients. Methods One hundred and sixteen patients undergone MHD therapy in our center for more than 3 months were enrolled in the study. Clinical data were collected for analysis. Ankle-brachial index (ABI) was used to estimate the presence of PAD. Patients were divided into PAD group (ABI<0.9) and nonestimate the association of PAD with PTX3 as well as other potential risk factors. Results The incidence of PAD was 18.1% (21/116). Plasma level of PTX3 was significantly higher in PAD patients than that in non-PAD patients [(5.55 ±2.63) μg/L vs (2.32 ±1.29)μg/L, P<0.01].Univariate analysis showed ABI values were negatively correlated with plasma PTX3 levels (r =-0.548, P<0.01), high-sensitivity C-reactive protein (hsCRP), age, blood glucose and triglyceride. ROC curve of PAD revealed that area under curve (AUC) of PTX3 was 0.901 (P<0.01). With the cut-off value of PTX3 as 4.06 μg/L, the diagnostic sensitivity and specificity in PAD were 81.0% and 91.5%. ROC curve of PAD showed that AUC of hsCRP was 0.640 (P<0.05). With the cut-off value of hsCRP as 3.33 mg/L, the diagnostic sensitivity and specificity in PAD were 57.1% and 56.8%. Using Logistic regression, plasma PTX3 was found to be associated with PAD (0R=9.755, 95%CI:2.359-19.354, P=0.001). Conclusions The PAD incidence of MHD patients in our center is 18.1%. Plasma PTX3 level is significantly correlated with the presence of PAD in MHD patients. The sensitivity and specificity of PTX3 are higher than those of hsCRP for PAD diagnosis.