目的  探讨几丁质酶3样蛋白1(chitinase-3-like protein 1，CHI3L1)水平与维持性血液透析(maintenance hemodialysis，MHD)患者动静脉内瘘(arteriovenous fistula，AVF)闭塞风险的相关性。 方法   纳入2023年1月─2024年3月会理市人民医院治疗的MHD患者168例，根据患者1年内是否发生AVF闭塞情况分为闭塞组(n=33)和对照组(n=135)，收集患者基线资料及CHI3L1水平，通过Logistic回归分析其与MHD患者AVF闭塞的相关性。 结果   闭塞组MHD患者与对照组原发疾病(χ2=6.390，  P=0.041)、血清白蛋白(t=2.133，P=0.037)、血清钙(t=2.703，P=0.010)、钙磷乘积(t=2.124，P=0.040)、CHI3L1(t=2.754，P=0.008)水平间差异有统计学意义；多因素Logistic回归分析显示：高血清白蛋白(OR=0.816，95%CI：0.719～0.926，P=0.002)是MHD患者AVF闭塞发生风险的保护因素，高血清钙(OR=1.641，95%CI：1.005～2.682，P=0.048)、高钙磷乘积(OR=1.053，95% CI：1.010～1.099，P=0.015)、高CHI3L1(OR=1.135，95%CI：1.077～1.195，P＜0.001)是MHD患者AVF闭塞发生风险危险因素；ROC曲线显示基线血清CHI3L1水平预测MHD患者AVF闭塞发生的曲线下面积为0.724，敏感度为62.96%，特异度为93.94%，阈值为123.13 ng/ml；联合预测的曲线下面积为0.811，敏感度为76.30%，特异度为75.76%。  结论   基线CHI3L1水平升高与AVF闭塞发生风险增加独立相关，可用于AVF闭塞的预测，但联合血清白蛋白、血清钙、钙磷乘积预测价值更高。

Objective  To investigate the association between serum chitinase-3-like protein 1 (CHI3L1) level and risk of arteriovenous fistula (AVF) occlusion in patients undergoing maintenance hemodialysis (MHD).  Method  A total of 168 patients undergoing MHD at the Huili People's Hospital between January 2023 and March 2024 were enrolled for this study. According to the occurrence of  AVF occlusion in a year, the patients were divided into the occlusion group (n=33) and the control group (n=135). Baseline clinical data and serum CHI3L1 level were collected from both groups. Logistic regression analysis was performed to investigate the correlation between serum CHI3L1 level and AVF occlusion in the MHD patients.  Results  There were statistically significant differences in primary disease (χ²=6.390, P=0.041), serum albumin (t=2.133, P=0.037), serum calcium (t=2.703, P=0.010), calcium-phosphorus product (t=2.124, P=0.040) and serum CHI3L1 level (t=2.754, P=0.008) between the occlusion group and the control group. Multivariate logistic regression analysis revealed that higher serum albumin (OR=0.816, 95% CI:0.719～0.926, P=0.002) was the protective factor against the risk of AVF occlusion (P<0.05), while higher serum calcium (OR=1.641, 95% CI:1.005～2.682, P=0.048), high calcium-phosphorus product (OR=1.053, 95% CI:1.010～1.099, P=0.015) and high serum CHI3L1 level (OR=1.135, 95% CI:1.077～1.195, P=0.000) were the independent risk factors for AVF occlusion in MHD patients. ROC curve analysis showed that the area under the curve (AUC) of baseline serum CHI3L1 level for predicting AVF occlusion in MHD patients was 0.724, with a sensitivity of 62.96%, a specificity of 93.94% and a cut-off serum CHI3L1 level of 123.13 ng/mL; the AUC of combined prediction model was 0.811, with a sensitivity of 76.30% and a specificity of 75.76%.  Conclusion  Elevated baseline CHI3L1 level is independently associated with the higher risk of AVF occlusion, and can be used for predicting AVF occlusion. Additionally, the combined use of serum albumin, serum calcium, and calcium-phosphorus product yields a higher predictive value for AVF occlusion in MHD patients.