中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (03): 182-186.doi: 10.3969/j.issn.1671-4091.2026.03.002

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清分泌型卷曲相关蛋白5、组蛋白去乙酰化酶4表达及其与不良心血管事件的关系

郭传琦    齐 欢   

  1. 066000 秦皇岛，北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院)1血液净化科 2肾病科
  • 收稿日期:2025-07-02 修回日期:2025-12-17 出版日期:2026-03-12 发布日期:2026-03-12
  • 通讯作者: 齐欢 E-mail:hbfffx@163.com
  • 基金资助:
    河北省中医药管理局科研计划项目(2025508)

The expression of serum SFRP5 and HDAC4 in maintenance hemodialysis patients and their relationship with major adverse cardiovascular events

GUO Chuan-qi, QI Huan   

  1. Department of Blood Purification, and ²Department of Nephrology, Qinhuangdao Hospital of Dongfang Hospital, Beijing University of Chinese Medicine (Qinhuangdao Hospital of Traditional Chinese Medicine), Qinhuangdao 066000, China
  • Received:2025-07-02 Revised:2025-12-17 Online:2026-03-12 Published:2026-03-12
  • Contact: 066000 秦皇岛，北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院)2肾病科 E-mail:hbfffx@163.com

摘要： 目的  探讨维持性血液透析(maintenance hemodialysis，MHD)患者血清分泌型卷曲相关蛋白5(ecretory coil-associated protein 5，SFRP5)、组蛋白去乙酰化酶4(histone deacetylase 4，HDAC4)表达及其与主要不良心血管事件(major adverse cardiovascular events，MACE)的关系。 方法  选取2021年9月—2023年9月在北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院)接诊的MHD患者为研究对象，根据随访MACE发生情况，分为发生组和未发生组。ELISA法测定血清SFRP5、HDAC4水平；分析MHD患者MACE的影响因素；评估血清SFRP5、HDAC4水平对MHD患者MACE的预测价值。 结果  共纳入167例患者，其中发生组57例、未发生组110例。发生组透析时长、低密度脂蛋白胆固醇、甲状旁腺激素、收缩压、舒张压均高于未发生组，残余肾肾小球滤过率(glomerular filtration rate，GFR)、残余肾肌酐清除率(creatinine clearance rat，Ccr)、尿素清除指数、血红蛋白低于未发生组(t=10.868、4.728、6.018、10.211、8.686、3.389、3.694、4.091、3.401，均P＜0.001)。与未发生组比较，发生组血清SFRP5、HDAC4表达水平均降低(t=7.939、7.547，均P＜0.001)。透析时长(OR=1.723，95%CI：1.047～2.835，P=0.032)、低密度脂蛋白胆固醇(OR=1.835，95%CI：1.151～2.926，P=0.011)、甲状旁腺激素(OR=2.175，95%CI：1.103～4.281，P=0.025)、残余肾GFR(OR=0.523，95%CI：0.317～0.864，P=0.011)、残余肾Ccr(OR=0.512，95%CI：0.277～0.948，P=0.033)、尿素清除指数(OR=0.379，95%CI：0.166～0.865，      P=0.021)、收缩压(OR=1.946，95%CI：1.035～3.658，P=0.039)、舒张压(OR=2.135，95%CI：1.079～4.223，P=0.029)、血红蛋白(OR=0.297，95%CI：0.107～0.821，P=0.019)、血清SFRP5(OR=0.479，95%CI：0.277～0.828，P=0.008)、HDAC4(OR=0.435，95%CI：0.238～0.796，P=0.007)是MHD患者MACE的影响因素。血清SFRP5、HDAC4联合预测MHD患者MACE的曲线下面积(area under the curv，AUC)为0.914，优于单独预测(Z二者联合-SFRP5=3.043、Z二者联合-HDAC4=2.770，P二者联合-SFRP5=0.002、P二者联合-HDAC4=0.006)。 结论  MHD患者血清SFRP5、HDAC4水平均降低，联合检测对MHD患者发生MACE具有更高的预测价值。

关键词: 分泌型卷曲相关蛋白5, 组蛋白去乙酰化酶4, 维持性血液透析, 不良心血管事件

Abstract: Objective  To measure serum levels of secreted frizzled-related protein 5 (SFRP5) and histone deacetylase 4 (HDAC4) in maintenance hemodialysis (MHD) patients, and to investigate their relationship with major adverse cardiovascular events (MACE).  Methods  From September 2021 to September 2023, 167 MHD patients admitted to our hospital were enrolled. According to the occurrence of MACE during follow-up, they were divided into a MACE group (n=57) and a non-MACE group (n=110). ELISA method was used to measure serum SFRP5 and HDAC4. The influencing factors of MACE in MHD patients were analyzed. To evaluate the predictive value of serum SFRP5 and HDAC4 levels for MACE in MHD patients  Results  In the MACE group, dialysis duration (47.65±10.25) months, low-density lipoprotein cholesterol (3.11±0.35) mmol/L, parathyroid hormone (321.89±47.88) ng/L, systolic blood pressure (145.26±15.28) mmHg, and diastolic blood pressure (95.21±11.27) mmHg were all significantly higher than those in the non-MACE group (33.49±6.52) months, (2.85±0.33) mmol/L, (298.54±49.53)ng/L, (122.08±13.15) mmHg, (81.25±9.03) mmHg, respectively. Conversely, residual kidney glomerular filtration rate (5.49±1.36 ml/min/1.73 m2), residual kidney creatinine clearance rate (25.72±3.98)L/week, urea clearance index (0.54±0.13), and hemoglobin (108.32±12.29) g/L in the MACE group were significantly lower than those in the non-MACE group (6.43±1.85)mL/min/1.73 m², (28.36±4.57)L/week, 0.65±0.18, and (116.07±14.75)g/L, respectively; all t-values from 3.389 to 10.868, P＜0.001). Serum levels of SFRP5 (32.68±7.45)μg/L and HDAC4 (29.56±4.85) pg/mL in the MACE group were significantly lower than those in the non-MACE group (42.95 ±8.16)μg/L and (38.92±6.48)pg/mL, respectively; t=7.939, 7.547, P＜0.001]. Multivariate analysis identified the following as independent factors influencing MACE (all P＜0.05): dialysis duration (OR=1.723, 95% CI:1.047～2.835), low-density lipoprotein cholesterol (OR=1.835, 95%CI: 1.151～2.926), parathyroid hormone (OR=2.175, 95%CI: 1.103～4.281), residual kidney GFR (OR=0.523, 95%CI: 0.317～0.864), residual kidney Ccr (OR=0.512, 95%CI: 0.277～0.948), urea clearance index (OR=0.379, 95%CI: 0.166～0.865), systolic blood pressure (OR=1.946, 95%CI: 1.035～3.658), diastolic blood pressure (OR=2.135, 95%CI: 1.079～4.223), hemoglobin (OR=0.297, 95%CI: 0.107～0.821), serum SFRP5 (OR=0.479, 95% CI: 0.277～0.828), and HDAC4 (OR=0.435, 95%CI: 0.238～0.796). The area under the curve (AUC) for the combination of serum SFRP5 and HDAC4 in predicting MACE was 0.914, which was superior to the predictive value of either marker alone (Z combined vs. SFRP5 alone = 3.043, P=0.002; Z combined vs. HDAC4 alone = 2.770, P=0.006).  Conclusion  Serum levels of SFRP5 and HDAC4 in MHD patients are both decreased. The combined detection has a higher predictive value for the occurrence of MACE in MHD patients.

Key words: Secreted frizzled related protein 5, Histone deacetylase 4, Maintenance hemodialysis; ,  , Major adverse cardiovascular events

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