目的 探讨维持性血液透析(maintenance hemodialysis，MHD)患者血清骨保护素(osteoprotegerin，OPG)、血清和糖皮质激素诱导蛋白激酶3(serum and glucocorticoid inducible kinase 3，SGK3)、溶质载体家族7成员11(solute carrier family 7 member 11，SLC7A11)水平与营养不良-炎症-动脉粥样硬化综合征(malnutrition-inflammation-atherosclerosis syndrome，MIAS)的关系及三者联合检测价值。 方法 选取2022年6月─2024年6月荆门市人民医院收治的MHD患者172例，将患者分为MIAS组(55例)、非MIAS组(117例)。应用Lasso回归分析、多因素Logistic回归分析、受试者工作特征(receiver operating characteristic，ROC)曲线进行分析。 结果 Lasso分析共筛选出高敏C反应蛋白(high-sensitivity C reactive protein，hs-CRP)、内膜中层厚度(intimal-medial thickness，IMT)、OPG、SGK3、SLC7A11为MIAS的预测因子。IMT(OR=2.951，95%CI：1.179～7.385，P=0.021)、OPG(OR=3.272，95%CI：1.339～7.998，P=0.009)、SGK3(OR=3.189，95%CI：1.362～7.466，P=0.008)是MHD患者并发的MIAS的危险因素，SLC7A11(OR=0.294，95%CI：0.122～0.706，P=0.006)是保护因素。血清OPG、SGK3、SLC7A11单独及联合预测MHD患者并发的MIAS的AUC为0.839、0.822、0.806、0.940，联合效能较优于较单独检测(Z=4.088、3.558、3.947，均P＜0.001)。 结论 MHD并发MIAS患者血清OPG、SGK3水平升高，SLC7A11水平下降，三者联合检测或可作为预测MHD患者发生MIAS的血清指标。
Abstract
Objective To investigate the relationship between serum levels of osteoprotegerin (OPG), serum and glucocorticoid inducible kinase 3 (SGK3), solute carrier family 7 member 11 (SLC7A11) and malnutrition-inflammation-atherosclerosis syndrome (MIAS) in patients undergoing maintenance hemodialysis (MHD), and to evaluate the value of their combined detection. Methods A total of 172 MHD patients admitted to Jingmen People's Hospital from June 2022 to June 2024 were enrolled and divided into MIAS group (55 cases) and non-MIAS group (117 cases). The analysis was conducted using Lasso regression, multivariate logistic regression and receiver operating characteristic (ROC) curves. Results Lasso analysis identified high-sensitivity C reactive protein (hs-CRP), intimal-medial thickness (IMT), OPG, SGK3, and SLC7A11 as predictors of MIAS. IMT (OR=2.951, 95%CI:1.179～7.385, P=0.021), OPG (OR=3.272, 95% CI:1.339～7.998, P=0.009), and SGK3 (OR = 3.189, 95% CI:1.362～7.466, P=0.008) were risk factors for MIAS in MHD patients, while SLC7A11 (OR = 0.294, 95% CI:0.122～0.706, P=0.006) was a protective factor. The area under the curve (AUC) of serum OPG, SGK3, and SLC7A11 alone and in combination for predicting MIAS in MHD patients was 0.839, 0.822, 0.806, and 0.940, respectively, with the combined efficacy being superior to that of each individual indicator (Z=4.088,3.558,3.947,all P＜0.001). Conclusion Serum OPG and SGK3 levels are elevated and SLC7A11 level is decreased in MHD patients with MIAS. The combined detection of these three indicators may serve as a serum biomarker for predicting MIAS in MHD patients.
关键词
维持性血液透析 /
营养不良-炎症-动脉粥样硬化综合征 /
骨保护素 /
血清和糖皮质激素诱导蛋白激酶3 /
溶质载体家族7成员11
Key words
Maintenance hemodialysis /
Malnutrition-inflammation-atherosclerosis syndrome /
Osteoprotegerin /
Serum and glucocorticoid inducible kinase 3 /
Solute carrier family 7 member 11
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参考文献
[1]Yang C, Gao B, Wang F, et al. Executive summary for the China kidney disease network (CK-NET) 2017-2018 annual data report[J]. Kidney Int, 2025, 107(6):980-984.
[2]Liu J, Zhang H, Diao Z, et al. Epidemiological analysis of death among patients on maintenance hemodialysis: results from the beijing blood purification quality Control and Improvement Center[J]. BMC Nephrol, 2023, 24(1):236-247.
[3]李娟, 卢婉君, 龚书豪, 等. 慢性肾衰竭腹膜透析患者微炎症状态的研究进展[J]. 南昌大学学报（医学版）, 2021, 61(3):80-83.
[4]Dong QQ, Tu YC, Gao P, et al. SGK3 promotes vascular calcification via Pit-1 in chronic kidney disease[J]. Theranostics, 2024, 14(2):861-878.
[5]Do Van T, Nguyen Minh T, et al. Serum osteoprotegerin level in hemodialysis patients using low-flux reused dialyzer in relation to atherosclerosis[J]. J Clin Lab Anal, 2021, 35(8):e23886-e23896.
[6]Gu X, Weng R, Deng Q, et al. Interleukin-17D accelerates atherosclerosis through promoting endothelial cells ferroptosis via CD93/miR-181a-5p/SLC7A11 signaling[J]. Int Immunopharmacol, 2024, 143(Pt 3):113558.
[7]马鸿杰, 刘梅, 张露凡, 等. 临床血液透析学[M]. 天津:天津科学技术出版社, 2001:125.
[8]李秋, 刘丽茹, 李潇, 等.维持性血液透析患者营养不良-炎症-动脉粥样硬化综合征的影响因素分析[J].中国当代医药, 2023, 30(29):19-24.
[9]马娉娉, 王斌, 厉兆春. 益肾逐瘀解毒法治疗维持性血液透析患者营养不良-炎症-动脉粥样硬化综合征临床观察[J]. 山东中医杂志, 2024, 43(3):271-276.
[10]Maraj M, Hetwer P, Ku?nierz-Cabala B, et al. α-Acid Glycoprotein and dietary intake in end-stage renal disease patients[J]. Nutrients, 2021, 13(11):3671-3681.
[11]Ohmure K, Kanda D, Ikeda Y, et al. Impact of co-presence of malnutrition-inflammation-atherosclerosis factors on prognosis in lower extremity artery disease patients after endovascular therapy[J]. Cardiovasc Interv Ther, 2025, 40(1):102-111.
[12]Liao QQ, Dong QQ, Zhang H, et al. Contributions of SGK3 to transporter-related diseases[J]. Front Cell Dev Biol, 2022, 10(1):1-9.
[13]张海福, 张媛媛, 张邢炜. 血清和糖皮质激素调节蛋白激酶1介导巨噬细胞在动脉粥样硬化过程中的作用[J]. 浙江医学, 2021, 43(10):1134-1136, 1140.
[14]Shu H, Wang Y, Zhang H, et al. The role of the SGK3/TOPK signaling pathway in the transition from acute kidney injury to chronic kidney disease[J]. Front Pharmacol, 2023, 14(1):1-8.
[15]朝琴, 薛治乾, 李文霞. miR-15b-5p靶向SGK1对高糖诱导小鼠足细胞损伤的影响[J]. 中国老年学杂志, 2021, 41(9):1913-1918.
[16]Dutka M, Bobiński R, Wojakowski W, et al. Osteoprotegerin and RANKL-RANK-OPG-TRAIL signalling axis in heart failure and other cardiovascular diseases[J]. Heart Fail Rev, 2022, 27(4):1395-1411.
[17]Zusi C, Bonetti S, Rinaldi E, et al. Interactions of the osteokines, glucose/insulin system and vascular risk networks in patients with newly diagnosed type 2 diabetes (VNDS 15)[J]. Diabetes Metab Res Rev, 2024, 40(7):e3847-e3857.
[18]Liu P, Xu X, Wang Y, et al. Effects of sodium thiosulfate on serum calcification factors in patients undergoing maintenance hemodialysis[J]. Ther Apher Dial, 2023, 27(6):1079-1087.
[19]Pazianas M, Miller PD. Osteoporosis and chronic kidney disease-mineral and bone disorder (CKD-MBD): Back to basics[J]. Am J Kidney Dis, 2021, 78(4):582-589.
[20]Lu CW, Wang CH, Hsu BG, et al. Serum osteoprotegerin level is negatively associated with bone mineral density in patients undergoing maintenance hemodialysis[J]. Medicina (Kaunas), 2021, 57(8):762-771.
[21]Xu X, Xu XD, Ma MQ, et al. The mechanisms of ferroptosis and its role in atherosclerosis[J]. Biomed Pharmacother, 2024, 171(2):1-6.
[22]Bai T, Li M, Liu Y, et al. Inhibition of ferroptosis alleviates atherosclerosis through attenuating lipid peroxidation and endothelial dysfunction in mouse aortic endothelial cell[J]. Free Radic Biol Med, 2020, 160(1):92-102.
[23]Bao X, Luo X, Bai X, et al. Cigarette tar mediates macrophage ferroptosis in atherosclerosis through the hepcidin/FPN/SLC7A11 signaling pathway[J]. Free Radic Biol Med, 2023, 201(1):76-88.
[24]董季秋, 吴越女, 蔡晓仪, 等. SLC39A8介导的铁稳态对糖尿病肾小管上皮细胞铁死亡的作用及机制研究[J]. 解剖科学进展, 2023, 29(6):561-564, 568.
[25]Wu J, Zhang J, Tang Q, et al. The significance of serum SLC7A11 levels in the occurrence of vascular calcification in maintenance peritoneal dialysis patients[J]. Nephrology (Carlton), 2024, 29(10):663-670.
[26]Du X, Ma X, Tan Y, et al. B cell-derived anti-beta 2 glycoprotein I antibody mediates hyperhomocysteinemia-aggravated hypertensive glomerular lesions by triggering ferroptosis[J]. Signal Transduct Target Ther, 2023, 8(1):103-112.
[27]张伟, 赵东, 周世菊. 甲状腺功能减和血清FGF23对维持性血液透析患者心血管病变的影响[J]. 分子诊断与治疗杂志, 2024, 16(7):1311-1314, 1319.
基金
荆门市科学技术研究与开发计划(2023YDKY029)
