血清PAF、MCP-1、FGF-23对终末期肾病维持性血液透析患者自体动静脉内瘘失功的预测价值

Predictive value of serum PAF, MCP-1, and FGF-23 for autologous arteriovenous fistula dysfunction in patients with end-stage renal disease undergoing maintenance hemodialysis

摘要:

目的 探究血清血小板活化因子（PAF）、单核细胞趋化蛋白-1（MCP-1）、成纤维细胞生长因子-23（FGF-23）对终末期肾病（ESRD）维持性血液透析（MHD）患者自体动静脉内瘘失功的预测价值。方法 选取2021年10月—2025年8月在华北医疗健康集团峰峰总医院行自体动静脉内瘘的240例ESRD-MHD患者作为研究对象，根据患者MHD期间是否发生自体动静脉内瘘失功分为未失功组（透析血流量≥200 mL/min，187例）和失功组（透析血流量<200 mL/min，53例）。全自动生化分析仪检测血肌酐、血磷、白蛋白、血尿素氮、血钙水平；免疫比浊分析仪检测D-二聚体（D-D）水平；酶联免疫吸附试验检测血清PAF、MCP-1、FGF-23水平。多因素一般Logistic回归模型分析ESRD-MHD患者发生自体动静脉内瘘失功的影响因素；受试者工作特征（ROC）曲线分析PAF、MCP-1、FGF-23联合对ESRD-MHD患者发生自体动静脉内瘘失功的预测价值。结果 失功组D-D、PAF、MCP-1、FGF-23水平均高于未失功组（P <0.05）。多因素一般Logistic回归分析，结果显示：D-D高［O^R=1.613（95% CI：1.103，2.359）］、PAF高［O^R=1.584（95% CI：1.035，2.424）］、MCP-1高［O^R=1.904（95% CI：1.119，3.239）］和FGF-23高［O^R=1.817（95% CI：1.164，2.835）］均为ESRD-MHD患者发生自体动静脉内瘘失功的危险因素（P <0.05）。ROC曲线分析结果显示，血清PAF、MCP-1、FGF-23、D-D水平单独及联合预测ESRD-MHD患者发生自体动静脉内瘘失功的曲线下面积分别为0.800（95% CI：0.744，0.849）、0.813（95% CI：0.758，0.860）、0.775（95% CI：0.717，0.827）、0.925（95% CI：0.884，0.955）。敏感性分别为83.0%（95% CI：0.772，0.876）、69.8%（95% CI：0.630，0.759）、77.4%（95% CI：0.710，0.827）、88.7%（95% CI：0.836，0.924），特异性分别为69.0%（95% CI：0.624，0.749）、77.5%（95% CI：0.714，0.828）、68.5%（95% CI：0.619，0.744）、82.4%（95% CI：0.766，0.870）。结论 血清PAF、MCP-1、FGF-23水平与ESRD-MHD患者AVF失功密切相关，三者联合预测ESRD-MHD患者发生AVF失功具有一定的临床意义，能够为临床疾病评估及治疗提供参考。

Abstract:

Objective To investigate the predictive value of serum platelet-activating factor (PAF), monocyte chemoattractant protein-1 (MCP-1), and fibroblast growth factor-23 (FGF-23) for autologous arteriovenous fistula (AVF) dysfunction in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis (MHD).Methods A total of 240 ESRD patients on MHD who underwent AVF creation at Fengfeng General Hospital of North China Medical and Health Group between October 2021 and August 2025 were enrolled. Patients were divided into two groups according to the occurrence of AVF dysfunction during follow-up: the non-dysfunction group (dialysis blood flow ≥ 200 mL/min, n = 187) and the dysfunction group (dialysis blood flow < 200 mL/min, n = 53). Serum creatinine (Scr), serum phosphorus, albumin (Alb), blood urea nitrogen (BUN), and serum calcium were measured using an automatic biochemical analyzer. D-dimer (D-D) levels were determined by immunoturbidimetry. Serum PAF, MCP-1, and FGF-23 levels were quantified by enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression analysis was performed to identify independent risk factors for AVF dysfunction. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of PAF, MCP-1, and FGF-23, alone and in combination.Results Serum D-D, PAF, MCP-1, and FGF-23 levels were higher in the dysfunction group than in the non-dysfunction group (P < 0.05). Multivariable logistic regression analysis showed that elevated D-D [O^R = 1.613 (95% CI: 1.103, 2.359) ], PAF [O^R = 1.584 (95% CI: 1.035, 2.424) ], MCP-1 [O^R = 1.904 (95% CI: 1.119, 3.239) ], and FGF-23 [O^R = 1.817 (95% CI: 1.164, 2.835) ] were risk factors for AVF dysfunction in ESRD-MHD patients (P < 0.05). The AUCs of PAF, MCP-1, FGF-23, and their combination for predicting AVF dysfunction were 0.800 (95% CI: 0.744, 0.849), 0.813 (95% CI: 0.758, 0.860), 0.775 (95% CI: 0.717, 0.827), and 0.925 (95% CI: 0.884, 0.955), respectively. The corresponding sensitivities were 83.0% (95% CI: 0.772, 0.876), 69.8% (95% CI: 0.630, 0.759), 77.4% (95% CI: 0.710, 0.827), and 88.7% (95% CI: 0.836, 0.924), and the corresponding specificities were 69.0% (95% CI: 0.624, 0.749), 77.5% (95% CI: 0.714, 0.828), 68.5% (95% CI: 0.619, 0.744), and 82.4% (95% CI: 0.766, 0.870), respectively.Conclusion Serum PAF, MCP-1, and FGF-23 levels are closely associated with AVF dysfunction in ESRD patients on MHD. The combination of these three markers demonstrates favorable predictive performance for AVF dysfunction, and may serve as a potential reference for clinical risk stratification and management.