终末期肾病透析患者血清去甲肾上腺素及血管紧张素Ⅱ在动静脉内瘘狭窄形成中的价值分析

Role of serum norepinephrine and angiotensin Ⅱ in arteriovenous fistula stenosis in dialysis patients with end-stage renal disease

摘要:

目的 探讨终末期肾病透析患者血清去甲肾上腺素（NE）和血管紧张素Ⅱ（AngⅡ）与动静脉内瘘狭窄形成的关系，评估NE和AngⅡ作为动静脉内瘘狭窄发生的生物标志物的价值。方法 选取2021年1月—2024年1月西安高新医院肾内科收治的190例终末期肾病透析患者作为研究对象，根据动静脉内瘘狭窄的有无分为狭窄组64例和非狭窄组126例。选取同期健康体检的40例成人为对照组。比较3组的血清NE和AngⅡ水平；比较两组终末期肾病透析患者的临床资料；采用多因素一般Logistic回归模型分析动静脉内瘘狭窄的影响因素，并通过ROC曲线评估NE和AngⅡ对终末期肾病透析患者动静脉内瘘狭窄的预测价值。结果 与对照组比较，狭窄组和非狭窄组患者血清NE和AngⅡ水平高（P <0.05）。狭窄组患者的Alb水平低于非狭窄组，CRP、NE、AngⅡ高于非狭窄组（P <0.05）。多因素一般Logistic回归模型结果显示，CRP水平高［O^R =1.331（95% CI：1.030，1.721）、NE水平高［O^R =1.015（95% CI：1.010，1.021）］、AngⅡ水平高［O^R =1.101（95% CI：1.054，1.150）］均是终末期肾病透析患者发生动静脉内瘘狭窄的危险因素（P <0.05）。Alb水平高［O^R =0.248（95% CI：0.066，0.932）是终末期肾病透析患者发生动静脉内瘘狭窄的保护因素（P <0.05）。ROC曲线分析结果显示，NE和AngⅡ联合检测对动静脉内瘘狭窄具有较高的预测价值，曲线下面积为0.943（95% CI：0.904，0.982），敏感性为84.4%（95% CI：0.731，0.922），特异性为93.7%（95% CI：0.879，0.972）。结论 终末期肾病透析患者血清NE、AngⅡ水平的升高与动静脉内瘘狭窄的发生有关，可作为预测动静脉内瘘狭窄的生物标志物。

Abstract:

Objective To investigate the relationship between serum norepinephrine (NE) and angiotensin Ⅱ (Ang Ⅱ) levels and arteriovenous fistula (AVF) stenosis in dialysis patients with end-stage renal disease (ESRD) and evaluate their potential as biomarkers for AVF stenosis.Methods A total of 190 ESRD dialysis patients admitted to the Department of Nephrology at Xi'an Gaoxin Hospital from January 2021 to January 2024 were enrolled. Based on the presence of AVF stenosis, patients were divided into a stenosis group (n = 64) and a non-stenosis group (n = 126). Forty healthy adults from the same period served as the control group. Serum NE and Ang Ⅱ levels were compared among the three groups. Clinical data of ESRD dialysis patients were analyzed, and multivariate logistic regression was used to identify risk factors for AVF stenosis. Receiver operating characteristic (ROC) curves assessed the predictive value of NE and Ang Ⅱ for AVF stenosis.Results Compared to the control group, the stenosis and non-stenosis groups exhibited significantly higher serum NE and Ang Ⅱ levels (both P < 0.05). The stenosis group had lower albumin (Alb) levels and higher C-reactive protein (CRP), NE, and Ang Ⅱ levels than the non-stenosis group (all P < 0.05). Multivariate analysis identified elevated CRP [O^R = 1.331 (95% CI: 1.030, 1.721) ], NE [O^R = 1.015 (95% CI: 1.010, 1.021) ], and Ang Ⅱ [O^R = 1.101 (95% CI: 1.054, 1.150) ] as independent risk factors for AVF stenosis (all P < 0.05). Higher Alb levels were a protective factor [O^R = 0.248 (95% CI: 0.066, 0.932) ], P < 0.05]. ROC analysis showed that combined NE and Ang Ⅱ testing had high predictive value for AVF stenosis [AUC = 0.943 (95% CI: 0.904, 0.982) ], with a sensitivity of 84.4% (95% CI: 0.731, 0.922) and specificity of 93.7% (95% CI: 0.879, 0.972).Conclusion Elevated serum NE and Ang Ⅱ levels in ESRD dialysis patients are associated with AVF stenosis and may serve as predictive biomarkers.