中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (05): 392-397.doi: 10.3969/j.issn.1671-4091.2025.05.007

• 临床研究 • 上一篇    下一篇

C反应蛋白清除率对维持性血液透析患者自体动静脉内瘘血管钙化的关系

冯伟勋   贾永盼   于海媛   韩 伟   

  1. 073000 定州，1定州市人民医院肾内科
  • 收稿日期:2024-06-11 修回日期:2025-03-07 出版日期:2025-05-12 发布日期:2025-05-12
  • 通讯作者: 韩伟 E-mail:45970111@qq.com

The relationship between CRP clearance and vascular calcification in native arteriovenous fistulas in maintenance hemodialysis patients

FENG Wei-xun, JIA Yong-pan, YU Hai-yuan, HAN Wei   

  1. Department of Nephrology, Dingzhou People’s Hospital, Dingzhou 073000, China
  • Received:2024-06-11 Revised:2025-03-07 Online:2025-05-12 Published:2025-05-12
  • Contact: 073000 定州，1定州市人民医院肾内科 E-mail:45970111@qq.com

摘要： 目的  探究C反应蛋白(CRP)清除率对维持性血液透析(hemodialysis，HD)患者自体动静脉内瘘(autologous arteriovenous fistula，AVF)血管钙化(vascular calcification，VC)的关系。 方法  选择2019年2月─2023年4月于定州市人民医院行内瘘修复术和慢性肾脏病(chronic kidney disease，CKD)G4～5初次内瘘共136例患者为研究对象，分为无VC组(54例)、轻中度VC组(52例)和重度VC组(30例)。采用LASSO回归进行临床特征筛选；采用多因素Logistic回归分析危险因素、建立预测模型，并进行模型评价。采用多元线性回归分析相关性。采用限制性立方样条(restricted cubic splines，RCS)及阈值效应分析剂量反应关系。 结果  LASSO回归筛选出年龄、糖尿病、高血压2级以上、24小时尿量、钙磷乘积、CRP清除率、VSMCs钙含量、ALP活性为预测因子；多因素Logistic回归分析显示：年龄(OR=3.062，95% CI：1.131～9.120，P＜0.001)、糖尿病(OR=1.851，95% CI：1.023～3.447，P=0.022)、钙磷乘积(OR=2.341，95% CI：1.052～6.076，P=0.005)、CRP清除率(OR=0.356，95% CI：0.123～0.507，  P=0.001)、钙化血管平滑肌细胞(VSMCs)钙含量(OR=1.904，95% CI：1.264～5.213，P=0.014)、血管组织碱性磷酸酶(ALP)活性(OR=2.197，95% CI：1.347～4.280，P=0.010)均是重度VC发生的独立影响因素。模型评价显示其区分度较好(验证后：灵敏度90.00%，特异度80.19%)，准确率82.35%，约登指数0.702。CRP清除率与VSMCs钙含量(β=-0.332，P=0.008)、ALP活性(β=-0.303，P=0.012)均呈负相关。CRP清除率连续变化与重度VC风险存在非线性关系(非线性检验P＜0.001)，且CRP清除率影响重度VC的折点为24.5%。 结论  CRP清除率与维持性HD患者AVF-VC存在一定的相关性，可作为监测AVF-VC的参考依据。

关键词: C反应蛋白, 血液透析, 动静脉内瘘, 血管钙化

Abstract: Objective  To explore the relationship between C-reactive protein (CRP) clearance and vascular calcification (VC) in native arteriovenous fistulas (AVF) in maintenance hemodialysis (HD) patients.  Methods A total of 136 patients who underwent fistula repair or primary fistula creation for chronic kidney disease (CKD) stages 4-5 at Dingzhou People's Hospital between February 2019 and April 2023 was studied. Patients were grouped into no VC (54 cases), mild-moderate VC (52 cases), and severe VC (30 cases). Clinical features were screened using LASSO regression. Multifactorial logistic regression identified risk factors, built a predictive model, and evaluated its performance. Correlations were analyzed with multiple linear regression, and dose-response relationships were assessed using restricted cubic splines (RCS) and threshold effect analysis. Results  LASSO regression identified age, diabetes, stage 2 hypertension, 24-hour urine volume, calcium-phosphate product, CRP clearance, vascular smooth muscle cell (VSMC) calcium content, and alkaline phosphatase (ALP) activity as predictive factors. Multifactorial logistic regression showed that age (OR=3.062,95% CI:1.131～9.120, P<0.001), diabetes (OR=1.851,95% CI:1.023～3.447, P=0.022), calcium-phosphate product (OR=2.341, 95% CI:1.052～6.076, P=0.005), CRP clearance (OR=0.356, 95% CI:0.123～0.507, P=0.001), VSMC calcium content (OR=1.904, 95% CI: 1.264～5.213, P=0.014), and ALP activity (OR=2.197, 95% CI:1.347～4.280, P=0.010) were independent risk factors for severe VC. The model demonstrated good discrimination (post-validation sensitivity 90.00%, specificity 80.19%), with an accuracy of 82.35% and Youden index 0.702. CRP clearance was negatively correlated with VSMC calcium content  (β=   -0.332, P=0.008) and ALP activity (β=-0.303, P=0.012). A nonlinear relationship was found between CRP clearance and severe VC risk (nonlinearity test P<0.001), with a CRP clearance inflection point at 24.5%.  Conclusion  CRP clearance is associated with AVF-VC in maintenance HD patients and can serve as a biomarker for monitoring AVF-VC.

Key words: C-reactive protein, Hemodialysis, Arteriovenous fistula, Vascular calcification

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