中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (11): 930-934.doi: 10.3969/j.issn.1671-4091.2025.11.011

• 临床研究 • 上一篇    下一篇

血清几丁质酶-3样蛋白-1、多配体蛋白聚糖4水平对急性肾损伤行血液透析治疗患者预后的预测价值

盖银玲  窦亚平  王 刚   

  1. 066000 秦皇岛，1河北港口集团有限公司秦皇岛中西医结合医院血液透析科
    050600 石家庄，2河北医科大学第一医院呼吸科
    050600 石家庄，3河北省中医院肾内科
  • 收稿日期:2025-02-20 修回日期:2025-07-10 出版日期:2025-11-12 发布日期:2025-11-12
  • 通讯作者: 盖银玲 E-mail:iae5w3@sina.com
  • 基金资助:
    河北省中医药管理局科研计划项目(2022038)

Predictive value of serum chitinase-3-like protein-1 and syndecan 4 levels for prognosis of acute renal failure patients undergoing hemodialysis

GAI Yin-ling, DOU Ya-ping, WANG Gang   

  1. Department of hemodialysis, Qinhuangdao integrated traditional Chinese and Western medicine hospital, Hebei Port Group Co., Ltd, Qinhuangdao 066000, China；2Department of respiration, the first hospital of Hebei Medical University, Shijiazhuang 050600, China；3Department of Nephrology, Hebei Provincial Hospital of traditional Chinese Medicine, Shijiazhuang 050600, China
  • Received:2025-02-20 Revised:2025-07-10 Online:2025-11-12 Published:2025-11-12
  • Contact: 066000 秦皇岛，1河北港口集团有限公司秦皇岛中西医结合医院血液透析科 E-mail:iae5w3@sina.com

摘要： 目的  探究血清几丁质酶-3样蛋白-1(chitinase-3-like protein-1，CHI3L1)、多配体蛋白聚糖4(syndecan 4，SDC4)水平对急性肾损伤(acute kidney injury，AKI)血液透析患者预后的预测价值。  方法  选择2019年1月—2021年8月河北港口集团有限公司秦皇岛中西医结合医院收治的接受血液透析治疗的AKI患者为研究组，根据1年的随访结果将患者分为生存组与死亡组；另选取同期健康体检者为对照组。检测血清CHI3L1、SDC4水平。采用COX回归分析影响因素；采用ROC曲线评估预测价值。采用Kaplan-Meier法进行生存分析。 结果  研究组共纳入150例患者，对照组150例。研究组血清CHI3L1、SDC4水平高于对照组(t=28.350、21.855，均P＜0.001)。死亡组血肌酐(t=3.722，P＜0.001)、尿酸(t=3.627，P＜0.001)、肿瘤坏死因子α(tumor necrosis factor-α，TNF-α)(t=3.557，P=0.001)、CHI3L1(t=6.299，P＜0.001)、SDC4(t=7.277，P＜0.001)均高于生存组。COX回归分析结果显示：血肌酐(HR=4.625，95% CI：2.027～10.555，P＜0.001)、尿酸(HR=4.334， 95% CI：2.038～9.217，P＜0.001)、TNF-α(HR=3.160，95% CI：1.642～6.081，P＜0.001)、CHI3L1(HR=5.227，95% CI：1.950～14.009，P=0.001)、SDC4(HR=4.816，95% CI：1.947～11.911，P＜0.001)均为AKI血液透析患者预后的影响因素。ROC曲线显示CHI3L1、SDC4及二者联合预测AKI血液透析患者预后不良的AUC分别为0.770(95%CI：0.694～0.835)、0.766(95%CI：0.690～0.831)、0.870(95%CI：0.806～0.920)，二者联合预测的AUC大于CHI3L1单独预测的AUC(Z=3.129，P=0.002)及SDC4单独预测的AUC(Z=2.600，P=0.009)。Kaplan-Meier曲线显示高CHI3L1组总体生存率低于低CHI3L1组(Log-rank χ2=62.729，P＜0.001)；高SDC4组总体生存率低于低SDC4组(Log-rank χ2=52.709，P＜0.001)。 结论 AKI患者血清CHI3L1、SDC4水平上升，二者为AKI血液透析患者预后的影响因素，二者联合检测对AKI血液透析患者预后不良的预测价值较高。

关键词: 急性肾损伤, 血液透析, 几丁质酶-3样蛋白-1, 多配体蛋白聚糖4, 预后

Abstract: Objective  To investigate the predictive value of serum chitinase-3-like protein-1 (CHI3L1) and syndecan 4 (SDC4) levels for the prognosis of patients with acute renal failure (AKI) undergoing hemodialysis.  Methods  AKI patients who received hemodialysis treatment in Qinhuangdao integrated traditional Chinese and Western medicine hospital of Hebei Port Group Co., Ltd, from January 2019 to August 2021 were selected as the study group. Based on 1-year follow-up results, patients were divided into a survival group and a death group. Additionally, healthy individuals undergoing physical examinations during the same period were selected as the control group. Serum levels of CHI3L1 and SDC4 were measured using enzyme-linked immunosorbent assay (ELISA). Cox regression was used to analyze the factors influencing the prognosis of AKI patients undergoing hemodialysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum CHI3L1 and SDC4 for prognosis of these AKI patients. Survival analysis was performed using the Kaplan-Meier method.   Results   The study group included 150 patients, and the control group included 150 individuals. The serum levels of CHI3L1 [(82.33±10.19) vs. (51.85±8.34) ng/L] and SDC4 [(6.89±1.65) vs. (3.40±1.05) ng/L] in the study group were higher than those in the control group (t=28.350, 21.855, P＜0.001). The creatinine (t=3.722, P＜0.001), uric acid (t=3.627, P＜0.001), tumor necrosis factor-α (TNF-α) (t=3.557, P=0.001), CHI3L1 (t=6.299, P＜0.001), and SDC4 (t=7.277, P＜0.001) in the death group were higher than those in the survival group (P＜0.05). COX regression analysis showed that serum creatinine (HR=4.625, 95% CI:2.027～10.555, P＜0.001), uric acid (HR=4.334, 95% CI:2.038～9.217, P＜0.001), TNF-α (HR=3.160, 95% CI:1.642～6.081, P＜0.001), CHI3L1 (HR=5.227, 95% CI:1.950～14.009, P=0.001), and SDC4 (HR=4.816, 95% CI:1.947～11.911, P＜0.001) were all factors affecting the prognosis of AKI patients undergoing hemodialysis . ROC curves revealed that the  area under the curve (AUC) of CHI3L1, SDC4, and their combination in predicting poor prognosis in AKI patients undergoing hemodialysis was 0.770 (95% CI: 0.694～0.835), 0.766 (95% CI: 0.690～0.831), and 0.870 (95% CI: 0.806～0.920), respectively.  The AUC for the combination was greater than that for CHI3L1 alone (Z=3.129, P=0.002) and for SDC4 alone (Z=2.600, P=0.009). Kaplan-Meier curves showed that the overall survival rate of the high CHI3L1 group was lower than that of the low CHI3L1 group (Log-rank χ²=62.729, P＜0.001); the overall survival rate of the high SDC4 group was lower than that of the low SDC4 group (Log-rank χ²=52.709, P＜0.001).  Conclusion  Serum levels of CHI3L1 and SDC4 are elevated in AKI patients and are factors influencing the prognosis of AKI patients undergoing hemodialysis. The combined detection of CHI3L1 and SDC4 has high predictive value for poor prognosis in these patients.

Key words: Acute kidney injury, Hemodialysis, Chitinase-3-like protein-1, Syndecan 4, Prognosis

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