中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (03): 207-211.doi: 10.3969/j.issn.1671-4091.2026.03.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者并发主要心血管不良事件的影响因素及血清不对称性二甲基精氨酸、核转录因子红系2相关因子2、消皮素D联合检测的预测价值

张龙飞    吴倩盼    刘建红   

  1. 维持性血液透析；主要心血管不良事件；不对称性二甲基精氨酸；核转录因子红系2相关因子2；消皮素D
  • 收稿日期:2025-06-05 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: 刘建红 E-mail:jh8286@163.com
  • 基金资助:
    国家重大疑难疾病慢性肾功能衰竭中西医协作项目(国中医药办医政发[201813]号)；临床医学研究中心项目：陕西省慢性肾病临床医学研究中心(2021LCZX-13)

Factors influencing major adverse cardiovascular events in patients undergoing maintenance hemodialysis and the predictive value of combined detection of serum ADMA, NRF2, and GSDMD

ZHANG Long-fei , WU Qian-pan , LIU Jian-hong   

  1. Department of Nephrology, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an 710000, China; 2Department of Cardiovascular Disease , Xi'an Municipal Hospital of Traditional Chinese Medicine, Xi'an 710000, China
  • Received:2025-06-05 Revised:2025-12-17 Online:2026-03-12 Published:2026-03-12
  • Contact: 710000 西安，1陕西省中医医院肾病一科 E-mail:jh8286@163.com

摘要： 目的  探讨维持性血液透析(maintenance hemodialysis，MHD)患者并发主要心血管不良事件(major adverse cardiovascular events，MACE)的影响因素，分析血清不对称性二甲基精氨酸(asymmetric dimethylarginine，ADMA)、核转录因子红系2相关因子2(nuclear factor erythroid 2 related factor 2，NRF2)、消皮素D(gasdermin D，GSDMD)联合检测对MACE发生的预测价值。 方法  选取2019年2月—2024年2月陕西省中医医院收治的MHD患者作为病例组，根据是否发生MACE分为MACE组与非MACE组。另选同期体检的健康志愿者作为对照组。受试者工作特征（receiver operating characteristic，ROC）曲线评估ADMA、NRF2、GSDMD对并发MACE的预测价值；多因素Logistic回归分析影响因素。结果  病例组共纳入238例患者，其中MACE组81例、非MACE组157例；对照组共纳入119例。与非MACE组相比，MACE组血清ADMA、NRF2、GSDMD及透析龄、超敏C反应蛋白(hypersensitive C-reactive protein，hs-CRP)、血磷、血钙、全段甲状旁腺激素水平升高（t=8.241、8.997、8.323、7.209、5.661、4.896、12.623、4.454，均P＜0.001）。血清ADMA、NRF2、GSDMD联合预测MHD患者并发MACE的曲线下面积(area under the curve，AUC)为0.934，高于单项检测(Z=4.631、3.553、3.691，均P＜0.001)。血钙(OR=2.661，95%CI：1.301～5.442，P=0.007)、全段甲状旁腺激素(OR=3.136，95%CI：1.477～6.656，P=0.003)、ADMA(OR=3.628，95%CI：1.802～7.304，P＜0.001)、NRF2(OR=4.129，95%CI：1.882～9.061，P＜0.001)、GSDMD(OR=3.284，95%CI：1.901～5.67，P＜0.001)是影响MHD患者并发MACE的危险因素。 结论  ADMA、NRF2、GSDMD、透析龄、血钙、全段甲状旁腺激素均为影响MHD患者并发MACE的危险因素，血清ADMA、NRF2、GSDMD联合检测对MHD患者发生MACE具有较高的预测价值。

关键词: 维持性血液透析, 主要心血管不良事件, 不对称性二甲基精氨酸, 核转录因子红系2相关因子2, 消皮素D

Abstract: Objective o investigate the influencing factors for major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD) and to analyze the predictive value of combined detection of serum asymmetric dimethylarginine (ADMA), nuclear factor erythroid 2-related factor 2 (NRF2), and gasdermin D (GSDMD) for the occurrence of MACE.  Methods  MHD patients admitted to Shaanxi Provincial Hospital of Traditional Chinese Medicine from February 2019 to February 2024 were selected as the case group and divided into a MACE group and a non-MACE group based on whether MACE occurred. Healthy volunteers undergoing physical examinations during the same period were selected as the control group. Serum levels of ADMA, NRF2, and GSDMD were measured by ELISA. The predictive value of combined serum ADMA, NRF2, and GSDMD for MACE was evaluated using ROC curve analysis. Multivariate logistic regression was used to analyze related risk factors affecting MACE occurrence.  Results  The case group included 238 patients, with 81 in the MACE group and 157 in the non-MACE group; the control group included 119 individuals. Compared with the control group, serum levels of ADMA, NRF2, and GSDMD were elevated in the case group (t=44.339, 41.996, 42.793, all P＜0.001). Compared with the non-MACE group, the MACE group showed increased serum levels of ADMA (t=8.241, P＜0.001), NRF2 (t=8.997, P＜0.001), GSDMD (t=8.323, P＜0.001), as well as longer dialysis vintage (t=7.209, P＜0.001), and higher levels of hypersensitive C-reactive protein (hs-CRP) (t=5.661, P＜0.001), serum phosphorus (t=4.896, P＜0.001), serum calcium (t=12.623, P＜0.001), and intact parathyroid hormone (iPTH) (t=4.454, P＜0.001). The area under the curve (AUC) for the combined prediction of MACE in MHD patients by serum ADMA, NRF2, and GSDMD was 0.934, which was higher than that of individual markers (Z=4.631, 3.553, 3.691, all P＜0.001). Serum calcium (OR=2.661, 95% CI: 1.301～5.442, P=0.007), iPTH (OR=3.136, 95% CI: 1.477～6.656, P=0.003), ADMA (OR=3.628, 95% CI: 1.802～7.304, P＜0.001), NRF2 (OR=4.129, 95% CI: 1.882～9.061, P＜0.001), and GSDMD (OR=3.284, 95% CI: 1.901～5.67, P＜0.001) were identified as risk factors for MACE in MHD patients.  Conclusion  ADMA, NRF2, GSDMD, dialysis vintage, serum calcium, and iPTH are all risk factors for MACE in MHD patients. Combined detection of serum ADMA, NRF2, and GSDMD has high predictive value for the occurrence of MACE in MHD patients.

Key words: Maintenance hemodialysis, Major adverse cardiovascular events, Asymmetric dimethylarginine, Nuclear factor erythroid 2 related factor 2, Gasdermin D

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