目的 探讨血清脂肪酸结合蛋白4(fatty acid binding protein 4，FABP4)、C1q/肿瘤坏死因子相关蛋白3(C1q/tumor necrosis factor related protein 3，CTRP3)与维持性血液透析(maintenance hemodialysis，MHD)患者不良心血管事件(major adverse cardiovascular events，MACE)的关系。 方法 收集2020年6月─2022年12月在邯郸市第一医院治疗的MHD患者140例。Pearson法分析相关性；相对危险度(relative risk，RR)分析对MACE发生的影响；多因素Logistic回归分析影响MACE发生的相关因素；受试者工作特征(receiver operating characteristic，ROC)曲线分析血清FABP4、CTRP3对MACE发生的预测价值。 结果 132例患者完成2年随访期，其中MACE组47例(35.61%)，无MACE组85例(64.39%)。血清FABP4与hs-CRP(r=0.487，P＜0.001)、TG(r=0.452，P＜0.001)呈正相关，与CTRP3(r=-0.503，P＜0.001)呈负相关；血清CTRP3与hs-CRP(r=-0.495，P＜0.001)、TG(r=-0.416，P=0.005)呈负相关。MHD患者中，血清FABP4高水平患者发生MACE的风险增加近1.4倍(RR=1.437，95%CI：1.130～1.919，P=0.003)，CTRP3低水平患者风险约升高1.6倍(RR=1.559，95%CI：1.183～2.054，P=0.001)。FABP4(OR=3.178，95%CI：1.783～5.666，P＜0.001)、hs-CRP(OR=2.532，95%CI：1.401～4.576，P=0.002)、iPTH(OR=2.484，95%CI：1.283～4.809，P=0.007)是MHD患者发生MACE的危险因素，CTRP3是保护因素(OR=0.392，95%CI：0.244～0.630，P＜0.001)。血清FABP4、CTRP3联合预测MHD患者发生MACE的曲线下面积(area under curve，AUC)高于单一指标(Z=2.517、2.055，P=0.008、0.023)。 结论 血清FABP4水平升高、CTRP3水平降低与MHD患者并发MACE有关，二者联合或可作为预测MACE发生的血清指标。
Abstract
Objective To investigate the relationship between serum fatty acid binding protein 4 (FABP4), C1q/tumor necrosis factor related protein 3 (CTRP3), and major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD). Methods A total of 140 patients with MHD treated at Handan First Hospital between June 2020 and December 2022 were enrolled. Pearson correlation analysis was used to assess correlations. Relative risk (RR) was applied to analyze the impact on MACE occurrence. Multivariate logistic regression was used to identify factors associated with MACE, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of serum FABP4 and CTRP3 for MACE. Results A total of 132 patients completed the 2-year follow-up period, including 47 patients (35.61%) in the MACE group and 85 patients (64.39%) in the non-MACE group. Serum FABP4 was positively correlated with hs-CRP (r=0.487,P <0.001) and TG (r=0.452,P<0.001), and negatively correlated with CTRP3 (r=−0.503,P<0.001). Serum CTRP3 was negatively correlated with hs-CRP (r=−0.495,P<0.001) and TG (r = −0.416,P=0.005). Among MHD patients, those with high serum FABP4 levels had an approximately 1.4-fold increased risk of MACE (RR=1.437,95%CI:1.130～1.919,P=0.003), while those with low CTRP3 levels had an approximately 1.6-fold increased risk (RR=1.559,95%CI: 1.183～2.054,P=0.001). FABP4 (OR=3.178, 95%CI:1.783～5.666,P<0.001), hs-CRP (OR=2.532, 95%CI:1.401～4.576,P=0.002), and iPTH (OR=2.484, 95%CI:1.283～4.809,P=0.007) were risk factors for MACE in MHD patients, while CTRP3 was a protective factor (OR=0.392, 95%CI: 0.244～0.630, P<0.001). The area under the curve (AUC) of the combination of serum FABP4 and CTRP3 for predicting MACE in MHD patients was higher than that of either indicator alone (Z=2.517,2.055;P=0.008,0.023). Conclusion Elevated serum FABP4 levels and reduced CTRP3 levels are associated with the occurrence of MACE in MHD patients. The combination of these two markers may serve as a serum indicator for predicting MACE.
关键词
维持性血液透析 /
脂肪酸结合蛋白4 /
C1q/肿瘤坏死因子相关蛋白3 /
不良心血管事件
Key words
Maintenance hemodialysis /
Fatty acid binding protein 4 /
C1q/tumor necrosis factor related protein 3 /
Major adverse cardiovascular events
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基金
邯郸市科学技术研究与发展计划项目(24422083044ZC)
