中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (10): 798-802.doi: 10.3969/j.issn.1671-4091.2025.10.002

• 临床研究 • 上一篇    下一篇

可溶性生长刺激表达基因2蛋白和冠状动脉钙化积分联合检测对维持性血液透析患者心血管事件发生的预测价值

程红娟    吴晓蓉    查 白   王建平    周 威   

  1. 211300 南京，1江苏大学附属南京市高淳人民医院肾内科
  • 收稿日期:2025-02-06 修回日期:2025-04-01 出版日期:2025-10-12 发布日期:2025-10-12
  • 通讯作者: 周威 E-mail:zhouwei99148028@qq.com
  • 基金资助:
    南京市卫生科技发展专项资金资助项目(YKK22246)

The predictive value of sST2 and CACS combined detection for cardiovascular events in patients with maintenance hemodialysis

CHENG Hong-juan，WU Xiao-rong，ZHA Bai，WANG jian-ping，ZHOU Wei   

  1. Department of Nephrology，Nanjing Gaochun People's Hospital Affiliated to JiangsuUniversity，Nanjing，Jiangsu，211300
  • Received:2025-02-06 Revised:2025-04-01 Online:2025-10-12 Published:2025-10-12
  • Contact: 211300 南京，1江苏大学附属南京市高淳人民医院肾内科 E-mail:zhouwei99148028@qq.com

摘要： 目的  探讨可溶性生长刺激表达基因2蛋白(soluble growth stimulation expressed gene2，sST2)联合冠状动脉钙化积分(coronary artery calcium score，CACS)对维持性血液透析(maintenance hemodialysis，MHD)患者心血管事件(cardiovascular event，CVE)发生的预测价值。 方法 纳入2022年1月─2022年12月在南京市高淳人民医院血液透析中心接受MHD治疗＞3个月的患者200例，收集临床资料，ELISA法检测血清sST2水平，多层螺旋CT检测CACS。分别以血清sST2、CACS中位数为界分组，随访2年，记录主要心血管事件。分析不同组间CVE发生率及影响CVE发生的相关危险因素，并探讨sST2联合CACS预测MHD患者CVE发生的价值。 结果  随访2年，200例MHD患者中CVE发生率为34.5%(69/200)。高sST2组(≥27.06 ng/ml)和高CACS组(≥183.5分)CVE发生率及累积风险均高于低水平组(sST2组：χ2=13.829，P＜0.001；χ2=15.797，P＜0.001；CACS组：χ2=18.608，P＜0.001；χ2=22.977，P＜0.001)。CVE组患者的年龄(t=2.858，P=0.005)、透析龄(Z=3.473，P=0.001)、糖尿病占比(χ2=4.029，   P=0.045)、低密度脂蛋白(t=1.987，P =0.047)、sST2(Z=4.743，P＜0.001)、CACS(Z=5.565，P＜0.001)水平高于无CVE组。多因素Logistic回归分析显示：高龄(OR=1.033，95% CI：1.000～1.066，P =0.047)、长透析龄(OR=1.009，95% CI：1.001～1.018，P=0.038)、高sST2(OR=1.073，95% CI：1.045～1.101，P＜0.001)及高CACS(OR =1.001，95% CI：1.000～1.002，P =0.002)是MHD患者发生CVE的独立危险因素。ROC曲线分析显示血清sST2、CACS联合预测MHD患者CVE发生的AUC为0.846，高于单一指标预测的0.724(Z =2.410，P =0.016)、0.749(Z =2.093，P =0.035)。 结论  MHD患者CVE发生率较高，血清sST2、CACS对MHD患者CVE发生均有良好的预测效能，两者联合检测预测价值更高。

关键词: 可溶性生长刺激表达基因2蛋白, 冠状动脉钙化积分, 血液透析, 心血管事件

Abstract: Objective  To explore the predictive value of soluble growth stimulation expressed gene2 (sST2) combined with coronary artery calcium score (CACS) for cardiovascular events (CVE) in patients undergoing maintenance hemodialysis (MHD).  Method  A total of 200 patients who received MHD treatment for more than 3 months at the Hemodialysis Center of Gaochun People’s Hospital in Nanjing from January to December 2022 were included. Clinical data were collected, serum sST2 levels were detected using ELISA, and CACS was assessed using multi-slice spiral CT. The patients were divided into groups according to the median value of serum sST2 and CACS. All patients were followed up for 2 years, andt major cardiovascular events were recorded. The incidence of CVE among different groups and related risk factors were analyzed to explore the value of sST2 combined with CACS in predicting CVE in MHD patients.  Results  After a 2-year-follow-up, the incidence of CVE among the 200 MHD patients was 34.5% (69/200). The high sST2 group (≥27.06ng/ml) and high CACS group (≥183.5 points) exhibited significantly higher incidence rates and cumulative risks of CVE compared to their low-level counterparts (sST2 group: χ2=13.829, P＜0.001; χ2=15.797, P＜0.001; CACS group: χ2=18.608, P＜0.001; χ2=22.977, P＜0.001). The following factors were significantly higher in the CVE group than in the non-CVE group: age (t=2.858, P=0.005), dialysis duration (Z=3.473, P =0.001), proportion of diabetes (χ2=4.029, P=0.045), low-density lipoprotein (t=1.987, P =0.047)，sST2 (Z=4.743, P＜0.001) and CACS (Z=5.565, P＜0.001). Multivariate Logistic regression analysis showed that advanced age (OR=1.033, 95% CI: 1.000～1.066, P=0.047), long dialysis duration (OR=1.009, 95% CI: 1.001～1.018, P =0.038), high sST2 (OR=1.073, 95% CI: 1.045～1.101, P＜0.001) and high CACS (OR=1.001, 95% CI: 1.000～1.002, P =0.002) were independent risk factors for CVE in MHD patients. ROC curve analysis revealed that the combination of serum sST2 and CACS in predicting CVE in MHD patients achieved an AUC of 0.846, surpassing the individual predictors with AUC values of 0.724(Z=2.410，P =0.016) and 0.749 (Z=2.093，P=0.035) , respectively.  Conclusion  The incidence of CVE in MHD patients is high. Both serum sST2 and CACS have good predictive value for CVE in MHD patients, but their combination has higher predictive value.

Key words: Soluble growth stimulation expressed gene2, Coronary artery calcium score, Hemodialysis, Cardiovascular event

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