目的  基于ROC曲线和决策曲线分析血清甾醇调节元件结合蛋白1(sterol regulatory element binding protein-1，SREBP1)、肾损伤分子-1(kidney injury molecule-1，KIM-1)、锌指蛋白Zic家族成员3(Zic family member 3，ZIC3)对维持性血液透析(maintenance hemodialysis，MHD)患者主要不良心血管事件(major adverse cardiac and cerebrovascular event，MACCE)发生的预测价值。 方法  前瞻性选取2021年5月—2024年5月于邯郸市第一医院进行MHD的患者为MHD组(n=189)，同期健康体检者为对照组(n=189)；根据是否发生MACCE，将MHD组患者分为MACCE组(n=51)和无MACCE事件(N-MACCE)组(n=138)；比较临床资料和血清SREBP1、KIM-1、ZIC3水平，并分析相关性；多因素分析影响MACCE的关联因素；ROC曲线和DCA曲线分析SREBP1、KIM-1、ZIC3水平对MACCE预测价值及临床实用性。 结果  与对照组比较，MHD组SREBP1、KIM-1水平较高，ZIC3水平较低(t=13.937、73.041、8.894，均P＜0.001)。与N-MACCE组比较，MACCE组透析龄、三酰甘油、血钙、SREBP1、KIM-1水平较高，ZIC3水平较低(t=4.156、2.802、3.644、5.812、6.081、5.764，P值分别为＜0.001、P=0.006、P＜0.001、P＜0.001、P＜0.001、P＜0.001)。SREBP1、KIM-1、ZIC3水平与透析龄、三酰甘油、血钙水平相关(r=0.435、0.327、0.514、0.503、0.352、0.487、-0.464、-0.381、-0.497，均P＜0.001)。透析龄、血钙、SREBP1、KIM-1、ZIC3均是MACCE发生的关联因素[OR=1.878(95%CI：1.189～2.965)、1.327(95%CI：1.080～1.630)、2.539(95%CI：1.449～4.447)、2.744(95%CI：1.454～5.178)、0.596(95%CI：0.432～0.822)，P=0.007、0.007、0.001、0.002、0.002]。SREBP1、KIM-1、ZIC3单独及联合预测MACCE的AUC为0.783、0.784、0.774和0.900，三者联合的预测价值较高(Z三者联合-SREBP1=2.601、Z三者联合-KIM-1=2.533、Z三者联合-ZIC3=2.857，P=0.009、0.011、0.004)。SREBP1、KIM-1、ZIC3联合预测模型的临床实用性较好。 结论  SREBP1、KIM-1、ZIC3在发生MACCE的MHD患者中异常表达，三者联合预测MACCE的价值和临床实用性较高。

Objective To analyze the predictive value of serum sterol regulatory element binding protein-1 (SREBP1), kidney injury molecule-1 (KIM-1), and zinc finger protein Zic family member 3 (ZIC3) levels for the occurrence of major adverse cardiac and cerebrovascular events (MACCE) in maintenance hemodialysis (MHD) patients.  Methods A total of 189 patients undergoing MHD in Handan First Hospital from May 2021 to May 2024 were prospectively enrolled as the MHD group, and a total of 189 healthy individuals from the health check-up department in the same period were recruited as the control group. Based on the presence or absence of MACCE, patients in the MHD group were further divided into MACCE group (n=51) and none MACCE (N-MACCE) group (n=138). Clinical data, serum levels of SREBP1, KIM-1 and ZIC3 were compared between MACCE and N-MACCE groups, and their correlations with MACCE were analyzed. Multivariate regression was conducted to explore the factors associated with MACCE. ROC curve and DCA curve were used to evaluate the predictive value and clinical practicability of serum levels of SREBP1, KIM-1 and ZIC3 for MACCE.  Results  The MHD group had higher serum levels of SREBP1 (t=13.937, P＜0.001) and KIM-1 (t=73.041, P＜0.001), and a lower level of ZIC3 (t=8.894, P＜0.001), as compared with those in the control group. The MACCE group had higher dialysis age (t=4.156, P＜0.001), triglyceride (t=2.802, P=0.006), blood calcium (t=3.644, P＜0.001), SREBP1 (t=5.812, P＜0.001), and KIM-1 levels (t=6.081, P＜0.001), and a lower ZIC3 level (t=5.764, P＜0.001), as compared with those in the N-MACCE group. Serum levels of SREBP1, KIM-1 and ZIC3 were significantly correlated with dialysis age (to SREBP1, r=0.435; to KIM-1, r=0.503; to ZIC3, r=-0.464; P＜0.001), triglyceride (to SREBP1, r=0.327; to KIM-1, r=0.352; to ZIC3, r=-0.381; P＜0.001) and blood calcium (to SREBP1, r=0.514; to KIM-1, r=0.487; to ZIC3, r=-0.497; P＜0.001). Dialysis age (OR=1.327, 95% CI: 1.080～1.630, P=0.007), blood calcium (OR=1.878, 95% CI: 1.189～2.965, P=0.007), SREBP1 (OR=2.539, 95% CI: 1.449～4.447, P=0.001), KIM-1 (OR=2.744, 95% CI: 1.454～5.178, P=0.002), and ZIC3 (OR=0.596, 95% CI: 0.432～0.822, P=0.002) were the associated factors for the occurrence of MACCE. The AUCs of serum SREBP1, KIM-1, ZIC3 and combination of the three serum levels for predicting MACCE were 0.783, 0.784, 0.774, and 0.900, respectively, indicating that combination of the three serum levels is better than SREBP1, KIM-1 or ZIC3 for predicting MACCE (Zcombination-SREBP1=2.601, P=0.009; Zcombination-KIM-1=2.533, P=0.011; Zcombination-ZIC3=2.857, P=0.004). When the high-risk threshold was set at 0.07～0.85, the prediction model of combined SREBP1, KIM-1 and ZIC3 levels had a better clinical practicability.  Conclusion Serum levels of SREBP1, KIM-1 and ZIC3 are abnormal in MHD patients with MACCE. Combination of the three serum levels has a higher value and clinical practicability for predicting MACCE.