目的  维持性血液透析(maintenance hemodialysis,MHD)患者血清单核细胞趋化蛋白-1(monocyte chemoattractant protein-1，MCP-1)、血管生成抑制蛋白-1(vasohibin-1，VASH-1)及烟酰胺腺嘌呤二核苷酸磷酸氧化酶4(nicotinamide adenine dinucleotide phosphatase oxidase 4，NOX4)水平变化及意义。 方法  选取2022年3月—2024年2月安徽医科大学附属合肥医院收治的MHD治疗患者，首次透析前、透析3个月后测定血清MCP-1、VASH-1及NOX4，根据预后情况分为预后不良组与预后良好组，比较2组一般资料及首次透析前、透析3个月后血清MCP-1、VASH-1及NOX4水平，Logistic回归分析MHD患者预后的影响因素，受试者工作特征(receiver operating characteristic，ROC)曲线评价MCP-1、VASH-1及NOX4差值对MHD患者预后的预测价值。 结果  共选取240例患者。随访1年，失访6例，共234例患者获得随访，其中预后不良组50例(占21.37%)，预后良好组184例。透析3个月后，2组患者血清MCP-1、VASH-1及NOX4水平均较首次透析前升高(t=23.361、37.308、13.511、19.689、12.967、18.486，均P＜0.001)，预后不良组血清MCP-1、VASH-1、NOX4水平及差值均高于预后良好组(t=7.384、12.974、6.409、12.638、5.415、12.296，均P＜0.001)；多因素Logistic回归分析显示：校正糖尿病、白蛋白后，  △MCP-1(OR=1.332，95%CI：1.106～1.605，P＜0.001)、△VASH-1(OR=1.383，95%CI：1.132～1.689，P＜0.001)、△NOX4(OR=1.313，95%CI：1.061～1.626，P＜0.001)仍与MHD患者预后独立相关；ROC曲线显示  △MCP-1、△VASH-1、△NOX4联合预测患者预后的曲线下面积(area under the curve，AUC)为0.869，大于各指标单独预测(Z联合-△MCP-1=2.497、P联合-△MCP-1＜0.001；Z联合-△VASH=2.566、P联合-△MCP-1＜0.001；Z联合-△NOX4=2.842、P联合-△MCP-1＜0.001)。 结论  MHD患者血清MCP-1、VASH-1、NOX4水平升高，差值与预后生存密切相关，   △MCP-1、△VASH-1、△NOX4联合预测预后效能较高，有助于临床早期识别高风险患者，及时优化、调整透析策略。

Objective  To investigate the changes and significance of serum Monocyte chemoattractant protein-1 (MCP-1), Vasohibin-1 (VASH-1) and Nicotinamide adenine dinucleotide phosphatase oxidase 4 (NOX4) levels in maintenance hemodialysis patients.  Methods A total of 240 patients with stage 5 chronic kidney disease admitted to Hefei Hospital Affiliated to Anhui Medical University from March 2022 to February 2024 were selected. All patients were treated with maintenance hemodialysis. Serum MCP-1, VASH-1 and NOX4 were measured before the first dialysis and three months after dialysis. According to the prognosis of patients, they were divided into poor prognosis group and good prognosis group. The general data and serum MCP-1, VASH-1 and NOX4 levels before the first dialysis and three months after dialysis were compared between the two groups. Logistic regression analysis was used to analyze the prognostic factors of maintenance hemodialysis patients. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of MCP-1, VASH-1 and NOX4 difference in the prognosis of CKD maintenance hemodialysis patients.  Results  A total of 240 maintenance hemodialysis patients were followed up for 1 year, and 6 patients were lost to follow-up, a total of 234 patients were followed up, of which 50 patients had poor prognosis, accounting for 21.37%, and were included in the poor prognosis group, the remaining 184 patients were included in the good prognosis group. After three months of dialysis, the levels of serum MCP-1, VASH-1 and NOX4 of patients in the poor prognosis group and the good prognosis group were significantly higher than those before the first dialysis, and the levels and differences of serum MCP-1, VASH-1 and NOX4 in the poor prognosis group were higher than those in the good prognosis group (t=7.384, 12.974, 6.409, 12.638, 5.415, 12.296, all P<0.001); multivariate. After adjusting for diabetes mellitus and albumin, △MCP-1 (OR=1.332,95%CI: 1.106-1.605, P<0.001), △VASH-1 (OR= 1.383,95%CI:1.132-1.689, P<0.001), △ NOX4 (OR=1.313,95%CI:1.061-1.626, P<0.001) were still independently associated with the prognosis of patients with CKD maintenance hemodialysis (P<0.05). The ROC curve showed that the area under the curve (AUC) value of △MCP-1, △VASH-1 and △NOX4 combined to predict the prognosis of maintenance hemodialysis patients was 0.869, which was significantly greater than that of each index alone (Zcombined-△MCP-1= 2.497, Pcombined-△MCP-1< 0.001; Zcombined-△VASH = 2.566, Pcombined-△MCP-1<0.001; Z combined-△NOX4= 2.842, P combined-△MCP-1<0.001).  Conclusion  The levels of serum MCP-1, VASH-1 and NOX4 in patients with maintenance hemodialysis are significantly increased, and the difference is closely related to the prognosis and survival. The combined prediction of △MCP-1, △VASH-1 and △NOX4 has higher prognostic efficacy, which is helpful for early clinical identification of high-risk patients and timely optimization and adjustment of dialysis strategies.