的  探讨维持性血液透析(maintenance hemodialysis，MHD)患者血腱糖蛋白C(tenascin-C，TN-C)、可溶性CD40配体(soluble CD40 ligand，sCD40L)和分泌型磷蛋白24(secreted phosphoprotein 24，SPP24)的变化及与心瓣膜钙化(cardiac valve calcification，CVC)的关系。 方法  以2022年1月─2025年5月河北中石油中心医院就诊的160例MHD患者为研究对象，收集患者一般资料并实施心脏超声检查，参照CVC的发生情况将其分为伴CVC组和非CVC组，比较2组的一般资料及血清TN-C、sCD40L和SPP24水平，分析MHD患者发生CVC的影响因素，并通过制作受试者工作特征(receiver operating characteristic，ROC)曲线评估血清TN-C、sCD40L和SPP24水平预测MHD患者发生CVC的效能。 结果  本研究纳入的MHD患者中发生CVC者83例(51.88%)。相较于非CVC组，伴CVC组患者年龄、透析龄、血磷、C反应蛋白、TN-C和sCD40L水平均较高(t=3.188、2.290、2.064、2.049、5.298、6.309，P=0.002、0.023、0.041、0.042、＜0.001、＜0.001)，血清白蛋白和SPP24水平均较低(t=2.234、5.271，P=0.027、  ＜0.001)。多因素Logistic回归分析表明：年龄增加、血清TN-C、sCD40L水平升高是MHD患者发生CVC的危险因素(OR=1.054、4.455、5.512，95%CI：1.010～1.101、1.484～13.377、1.997～15.215，P=0.016、0.008、0.001)，SPP24水平升高是MHD患者发生CVC的保护因素(OR=0.322，95%CI：0.145～0.713，P=0.005)。血清TN-C、sCD40L和SPP24单独及联合预测MHD患者发生CVC的AUC分别为0.746、0.680、0.752和0.858，联合预测的AUC高于TN-C、sCD40L和SPP24单一指标预测的AUC(Z=3.333、4.277、3.347，均P＜0.001)。 结论  MHD并发CVC患者血清TN-C和sCD40L水平均升高，SPP24水平降低，且上述指标的联合检测用于预测MHD患者发生CVC具有较高的临床效能。

Objective To investigate the changes in serum tenascin-C (TN-C), soluble CD40 ligand (sCD40L), and secreted phosphoprotein 24 (SPP24) in patients undergoing maintenance hemodialysis (MHD) and their relationship with cardiac valve calcification (CVC).  Methods  A total of 160 MHD patients treated at Hebei PetroChina Central Hospital from January 2022 to May 2025 were selected as the study subjects. General data were collected, and cardiac ultrasound examinations were performed. According to the occurrence of CVC, the patients were divided into a CVC group and a non-CVC group. The general data and serum levels of TN-C, sCD40L, and SPP24 were compared between the two groups. The influencing factors for CVC in MHD patients were analyzed, and receiver operating characteristic (ROC) curves were constructed to evaluate the efficacy of serum TN-C, sCD40L, and SPP24 levels in predicting CVC in MHD patients.  Results  Among the MHD patients included in this study, 83 (51.88%) developed CVC. Compared with the non-CVC group, patients in the CVC group had higher age, dialysis vintage, serum phosphorus, C-reactive protein, TN-C, and sCD40L levels (t=3.188, 2.290, 2.064, 2.049, 5.298, 6.309; P=0.002, 0.023, 0.041, 0.042, ＜0.001, ＜0.001), and lower serum albumin and SPP24 levels (t=2.234, 5.271; P=0.027, ＜0.001). Multivariate logistic regression analysis showed that increased age and elevated serum TN-C and sCD40L levels were risk factors for CVC in MHD patients (OR=1.054, 4.455, 5.512; 95% CI: 1.010～1.101, 1.484～13.377, 1.997～15.215; P=0.016, 0.008, 0.001), while elevated SPP24 levels were a protective factor for CVC in MHD patients (OR=0.322; 95% CI: 0.145～0.713; P=0.005). The AUCs of serum TN-C, sCD40L, and SPP24 alone and in combination for predicting CVC in MHD patients were 0.746, 0.680, 0.752, and 0.858, respectively. The AUC of the combined prediction was higher than that of TN-C, sCD40L, and SPP24 alone (Z=3.333, 4.277, 3.347; all P＜0.001).  Conclusion  In MHD patients with CVC, serum TN-C and sCD40L levels are elevated, while SPP24 levels are decreased. The combined detection of these indicators has high clinical efficacy in predicting CVC in MHD patients.