中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 979-983.doi: 10.3969/j.issn.1671-4091.2025.12.003

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清Krüppel样因子4、硫氧还蛋白相互作用蛋白表达与血管钙化的关系

李 荣   冯 璐   徐程远   

  1. 071000 保定，1保定市第一医院血透室
    100080 北京，2北京大学第三医院急诊科
    063000 唐山，3唐山中山医院放射科
  • 收稿日期:2025-05-27 修回日期:2025-08-24 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 李荣 E-mail:bqjbdy@163.com

The relationship between serum KLF4, TXNIP expression and vascular calcification in maintenance hemodialysis patients

LI  Rong, FENG  Lu, XU Cheng-yuan   

  1. Hemodialysis Room, Baoding First Hospital, Baoding, Hebei 071000, China; 2Emergency Department, Peking University Third Hospital, Beijing 100080, China; 3Department of Radiology, Tangshan Zhongshan Hospital, Tangshan, Hebei 063000, China
  • Received:2025-05-27 Revised:2025-08-24 Online:2025-12-12 Published:2025-12-12
  • Contact: 071000 保定，1保定市第一医院血透室 E-mail:bqjbdy@163.com

摘要： 目的  分析维持性血液透析(maintenance hemodialysis，MHD)患者血清Krüppel样因子4(Kruppel-like factor 4，KLF4)、硫氧还蛋白相互作用蛋白(thioredoxin-interacting proteins，TXNIP)表达与血管钙化(vascular calcification，VC)的关系。 方法  选择2019年3月—2024年3月于保定市第一医院接受MHD的患者为研究对象。依据是否存在VC分为钙化组和无钙化组。收集患者性别、年龄、体质量指数(body mass index，BMI)、透析龄、吸烟、饮酒、原发病等资料，检测白蛋白、血磷、血钙、血肌酐、尿素氮、空腹血糖、血红蛋白、全段甲状旁腺激素(intact parathyroid hormone，iPTH)，计算尿素清除指数(urea removal index，Kt/V)、肾小球滤过率。酶联免疫吸附(enzyme-linked immunosorbent assay，ELISA)法测定KLF4、TXNIP。Pearson法分析相关性；多因素Logistic回归及危险度分析KLF4、TXNIP对VC的影响；采用受试者工作特征曲线(receiver operating characteristic curve，ROC)评估预测价值；临床决策曲线(clinical decision curve，DCA)评估模型的临床使用价值。 结果  共纳入142例患者，其中钙化组98例，无钙化组44例。钙化组KLF4、TXNIP均高于无钙化组(t=7.312、8.419，均P＜0.001)。相关性分析提示：KLF4与年龄、透析龄、空腹血糖、血磷、iPTH呈正相关(r=0.425、0.328、0.396、0.550、0.386，均P＜0.001)，与血红蛋白、白蛋白呈负相关(r=-0.397、-0.315，均P＜0.001)；TXNIP与年龄、透析龄、空腹血糖、血磷、iPTH呈正相关(r=0.407、0.501、0.421、0.385、0.314，均P＜0.001)，与血红蛋白、白蛋白呈负相关(r=-0.437、-0.418，均P＜0.001)。多因素Logistic分析显示KLF4(OR=2.591，95% CI：1.434～4.683，P=0.002)、TXNIP(OR=1.926，95% CI：1.505～2.466，P＜0.001)是VC的影响因素。危险度分析显示血清KLF4、TXNIP高水平患者发生VC的风险分别是低水平患者的1.483(1.149～1.915)倍、1.432(1.125～1.822)倍。ROC曲线显示KLF4、TXNIP联合检测对VC预测的AUC为0.930(Z联合-KLF4=2.232、P联合-KLF4=0.026；Z联合-TXNIP=2.432、P联合-TXNIP=0.015)。DCA曲线表明高风险阈值概率为0.26～0.95时，应用该ROC曲线模型预测VC发生的临床使用价值较高。 结论  MHD发生VC的患者KLF4、TXNIP均高表达，二者均与MHD患者VC的发生有关，二者联合预测MHD患者VC的价值较高。

关键词: 维持性血液透析, 血管钙化, Krüppel样因子4, 硫氧还蛋白相互作用蛋白

Abstract: Objective  To analyze the relationship between the expression of serum Krüppel-like factor 4 (KLF4), thioredoxin-interacting protein (TXNIP) and vascular calcification (VC) in maintenance hemodialysis (MHD) patients.  Methods  Patients who received MHD at Baoding First Hospital from March 2019 to March 2024 were selected as the study subjects. They were divided into a calcification group and a non-calcification group based on the presence or absence of VC. Data on gender, age, Body Mass Index (BMI), dialysis vintage, smoking, alcohol consumption and primary disease were collected. Serum levels of albumin, blood phosphorus, blood calcium, blood creatinine, urea nitrogen and fasting blood glucose were measured using a DXI-800 automatic biochemical analyzer. Hemoglobin was detected by an automated hematology analyzer, intact parathyroid hormone (iPTH) was detected by electrochemiluminescence. The urea removal index (Kt/V) and glomerular filtration rate were calculated. The levels of KLF4 and TXNIP were determined by enzyme-linked immunosorbent assay (ELISA). The Pearson correlation method was used for correlation analysis. Multivariate Logistic regression and risk analysis were performed to evaluate the effects of KLF4 and TXNIP on VC. The predictive value was evaluated using the receiver operating characteristic (ROC) curve, and the clinical application value of the model was evaluated by decision curve analysis (DCA).  Results  The KLF4 and TXNIP levels in the calcification group were significantly higher than those in the non-calcification group (t=7.312, 8.419; both P＜0.001). Pearson analysis showed that KLF4 was positively correlated with age, dialysis vintage, fasting blood glucose, blood phosphorus, and iPTH (r=0.425, 0.328, 0.396, 0.550, 0.386), and negatively correlated with hemoglobin and albumin (r=-0.397, -0.315). TXNIP was positively correlated with age, dialysis vintage, fasting blood glucose, blood phosphorus, and iPTH (r=0.407, 0.501, 0.421, 0.385, 0.314), and negatively correlated with hemoglobin and albumin (r=-0.437, -0.418), all P＜0.001 Multivariate Logistic analysis showed that KLF4 [OR (95% CI) =2.591 (1.434～4.683), P=0.002] and TXNIP [OR (95% CI) =1.926 (1.505～2.466), P＜0.001] were both independent influencing factors for VC (P＜0.05). Risk analysis showed that the risk of VC in patients with high levels of serum KLF4 and TXNIP was 1.483 (1.149～1.915) times and 1.432 (1.125～1.822) times that of patients with low levels, respectively. The ROC curve showed that the AUC of the combined KLF4 and TXNIP for VC prediction was 0.930 (Z combined VS KLF4=2.232, P=0.026) (Z combined VS TXNIP=2.432, P=0.015). The DCA indicated that when the high-risk threshold probability ranges from 0.26 and 0.95, the combined model has high clinical application value in predicting the occurrence of VC. Conclusion  Patients with VC after MHD exhibit high expression of KLF4 and TXNIP. Both factors are related to the occurrence of VC in MHD patients. The combined of KLF4 and TXNIP has high prediction value of VC in MHD patients.

Key words: Maintenance hemodialysis, Vascular calcification, Krüppel-like factor 4, Thioredoxin interacting protein

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