中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (11): 951-955.doi: 10.3969/j.issn.1671-4091.2025.11.016

• 血管通路 • 上一篇    下一篇

血清基质金属蛋白酶-2、血管细胞粘附分子-1对维持性血液透析患者自体动静脉内瘘失功的预测价值

张明慧   万国萍   栾 森   

  1. 257100 东营，1胜利油田中心医院肾内科
  • 收稿日期:2025-03-27 修回日期:2025-06-06 出版日期:2025-11-12 发布日期:2025-11-12
  • 通讯作者: 栾森 E-mail:13805466480@163.com
  • 基金资助:
    济南市科技创新发展计划(202134046)

The predictive value of serum MMP-2 and VCAM-1 for autogenous arteriovenous fistula failure in maintenance hemodialysis patients

ZHANG Ming-hui, WAN Guo-ping, LUAN Sen   

  1. Department of Nephrology, Shengli Oilfield Central Hospital, Dongying 257100, China
  • Received:2025-03-27 Revised:2025-06-06 Online:2025-11-12 Published:2025-11-12
  • Contact: 257100 东营，1胜利油田中心医院肾内科 E-mail:13805466480@163.com

摘要： 目的  探究血清基质金属蛋白酶-2(matrix metalloproteinase-2，MMP-2)、血管细胞粘附分子-1(vascular cell adhesion molecule-1，VCAM-1)对维持性血液透析(maintenance hemodialysis，MHD)患者自体动静脉内瘘(autogenous arteriovenous fistula，AVF)失功的预测价值。 方法 选取2021年3月─2024年6月在胜利油田中心医院进行MHD的患者，根据AVF失功临床诊断标准将患者分为AVF正常组与AVF失功组。检测患者血清MMP-2、VCAM-1水平；收集血钙、血磷、血红蛋白、血小板水平等实验室指标。采用Spearman进行相关性分析；使用多因素Logistic回归模型分析MHD患者AVF失功的影响因素；采用ROC曲线分析血清MMP-2、VCAM-1对MHD患者AVF失功的预测价值。 结果 共纳入197例患者，其中AVF正常组116例，AVF失功组81例。AVF失功组透析时低血压(χ2=9.167，P=0.002)、内瘘狭窄(χ2=19.391，P＜0.001)、高凝倾向(χ2=43.585，P＜0.001)、低血小板水平(χ2=20.494，P＜0.001)、内瘘拔针压迫时间≥30 min人数(χ2=26.204，P＜0.001)、血清MMP-2(t=7.640，P＜0.001)、VCAM-1(t=7.801，P＜0.001)水平与AVF正常组比较差异有统计学意义。MHD患者内瘘狭窄、高凝倾向、内瘘拔针压迫时间与血清MMP-2(r/rs=0.510、0.443、0.431，均P＜0.001)、VCAM-1(r/rs=0.519、0.436、0.455，均P＜0.001)水平呈正相关，血压、血小板与血清MMP-2(r=-0.462、-0.605，均P＜0.001)、VCAM-1(r=-0.465、-0.623，均P＜0.001)水平呈负相关。透析时低血压(OR=2.964，95% CI：1.516～5.794，P=0.001)、低血小板水平(OR=2.974，95% CI：1.463～6.046，P=0.003)、高凝倾向(OR=2.879，95% CI：1.405～5.899，P=0.004)、内瘘拔针压迫时间≥30 min(OR=3.246，95% CI：1.737～6.066，P＜0.001)、MMP-2(OR=3.447，95% CI：1.830～6.492，P＜0.001)、VCAM-1(OR=3.426，95%CI：1.971～5.954，P＜0.001)是MHD患者发生AVF失功的风险因素；血清MMP-2、VCAM-1预测MHD患者AVF失功的AUC分别为0.789、0.785，二者联合预测的AUC为0.889，优于单独诊断(二者联合-MMP-2：Z=3.323、P=0.001；二者联合-VCAM-1：Z=3.486，P=0.001)。 结论 MMP-2、VCAM-1与MHD患者内瘘狭窄、高凝倾向、内瘘拔针压迫时间呈正相关，与血压、血小板呈负相关；MMP-2、VCAM-1均可以预测MHD患者AVF失功，二者联合预测效果更好。

关键词: 维持性血液透析, 自体动静脉内瘘失功, 基质金属蛋白酶-2, 血管细胞粘附分子-1

Abstract: Objective To investigate the predictive value of serum matrix metalloproteinase-2 (MMP-2) and vascular cell adhesion molecule-1 (VCAM-1) for autogenous arteriovenous fistula (AVF) failure in maintenance hemodialysis (MHD) patients.  Methods   A total of 197 uremic patients undergoing MHD in this hospital from March 2021 to June 2024 were selected as the research subjects. According to the diagnostic criteria for AVF failure, the patients were assigned into an AVF normal group (116 cases) and an AVF failure group (81 cases). Enzyme linked immunosorbent assay (ELISA) kits were used to detect serum MMP-2 and VCAM-1. Laboratory indicators including blood calcium and phosphorus, hemoglobin, and platelet were routinely detected. Spearman correlation analysis was used for correlation analysis. Multivariate logistic regression model was applied to analyze the influencing factors for AVF failure in MHD patients. Receiver operating characteristic (ROC) was applied to analyze the predictive value of serum MMP-2 and VCAM-1 for AVF failure in MHD patients.  Results  In AVF failure group, intradialytic hypotension (χ2=9.167, P=0.002), AVF stenosis (χ2=19.391, P＜0.001), hyper-coagulation predisposition (χ2=43.585, P＜0.001), low platelet (χ2=20.494, P＜0.001), compression time ≥30 min on puncture site (χ2=26.204, P＜0.001), serum MMP-2 (t=7.640, P＜0.001) and serum VCAM-1 (t=7.801, P＜0.001) were higher than those in AVF normal group. AVF stenosis, hyper-coagulation predisposition, and compression time on puncture site were positively correlated with serum MMP-2 (r/rs=0.510, 0.443 and 0.431 respectively; P＜0.001) and serum VCAM-1 (r/rs=0.519, 0.436 and 0.455 respectively; P＜0.001), while blood pressure and platelet were negatively correlated with serum MMP-2 (r=-0.462 and -0.605; P＜0.001) and serum VCAM-1 (r=-0.465 and -0.623; P＜0.001) levels. Intradialytic hypotension (OR=2.964, 95% CI: 1.516～5.794, P=0.001), low platelet (OR=2.974, 95% CI: 1.463～6.046, P=0.003), hyper-coagulation predisposition (OR=2.879, 95% CI: 1.405～5.899, P=0.004), compression time ≥30 minutes on puncture site (OR=3.246, 95% CI: 1.737～6.066, P＜0.001), serum MMP-2 (OR=3.447, 95% CI: 1.830～6.492, P＜0.001) and serum VCAM-1 (OR=3.426, 95% CI: 1.971～5.954, P＜0.001) were the risk factors for AVF failure in MHD patients. The area under the curves (AUC) of serum MMP-2 and serum VCAM-1 for predicting AVF failure were 0.789 and 0.785 respectively; the AUC of combined serum MMP-2 and VCAM-1 for the prediction was 0.889, which was superior to the prediction ability using serum MMP-2 (Z=3.323, P=0.001) or serum VCAM-1 (Z=3.486, P=0.001) alone.  Conclusion  MMP-2 and VCAM-1 are positively correlated with AVF stenosis, hyper-coagulation predisposition, and longer compression time on puncture site, and negatively correlated with blood pressure and platelet level. Serum MMP-2 and VCAM-1 can predict AVF failure in MHD patients, and combination of the two serum levels obtains better prediction ability.

Key words: Maintenance hemodialysis, Autogenous arteriovenous fistula failure, Matrix metalloproteinase-2, Vascular cell adhesion molecule-1

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