中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (04): 335-340.doi: 10.3969/j.issn.1671-4091.2026.04.012

• 血管通路 • 上一篇    下一篇

血清清巨噬细胞炎性蛋白-1α、几丁质酶-3样蛋白、含pyrin结构域的NOD样受体3与导管相关性感染及预后的相关性分析

张文强   刘鸿飞   仇 燚   

  1. 646000 泸州，1西南医科大学附属泸州市中医医院肾内科
  • 收稿日期:2025-06-19 修回日期:2026-01-16 出版日期:2026-04-12 发布日期:2026-04-12
  • 通讯作者: 仇燚 E-mail:y3kdpkjw@163.com

Correlation of serum levels of MIP-1α, YKL-40 and NLRP3 with catheter-related infections and prognosis

ZHANG Wen-qiang, LIU Hong-fei, QIU Yi   

  1. Department of Nephrology, Luzhou Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou 646000, China
  • Received:2025-06-19 Revised:2026-01-16 Online:2026-04-12 Published:2026-04-12
  • Contact: 646000 泸州，1西南医科大学附属泸州市中医医院肾内科 E-mail:y3kdpkjw@163.com

摘要： 目的  研究分析维持性血液透析患者血清巨噬细胞炎性蛋白-1α(macrophage inflammatory protein-1α,MIP-1α)、几丁质酶-3样蛋白1(chitinase-3-like protein 1,CHI3L1/YKL-40)、含pyrin结构域的NOD样受体3(NOD like receptor family pyrin domain-containing protein 3,NLRP3)水平与导管相关性感染及预后的相关性。 方法  选取泸州市中医医院在2020年1月─2024年8月收治的维持性血液透析患者296例，根据是否发生导管感染分为感染组(n=68)和未感染组(n=228)，根据预后情况分为预后良好组(n=42)和预后不良组(n=26)，经ELISA检测血清MIP-1α、YKL-40、NLRP3水平，收集分析一般临床资料，多因素Logistic回归分析患者预后影响因素，受试者工作特征(receiver operating characteristic，ROC)曲线分析MIP-1α、YKL-40、NLRP3对患者预后的预测价值，Pearson及Spearman法分析MIP-1α、YKL-40、NLRP3与炎症因子及预后的相关性。 结果  与非感染组相比，感染组的血清MIP-1α、YKL-40、NLRP3、C反应蛋白(C-reactive protein，CRP)、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)、降钙素原(procalcitonin，PCT)水平显著升高(t=14.532、14.561、22.823、28.495、11.487、22.234，均P＜0.001)；预后不良组的透析龄、透析频率、MIP-1α、YKL-40、NLRP3、CRP、TNF-α、PCT水平显著高于预后良好组(t=3.293、3.293、8.410、7.432、7.511、15.045、3.694、4.007，   P=0.002、0.001、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001)；ROC曲线显示MIP-1α、YKL-40、NLRP3三者联合对患者预后预测的AUC显著高于MIP-1α(Z=2.101，P=0.036)、YKL-40(Z=2.610，    P=0.009)、NLRP3(Z=2.965，P=0.003)单独预测；MIP-1α、YKL-40、NLRP3与炎症因子CRP(r=0.462、0.466、0.472，均P＜0.001)、TNF-α(r=0.436、0.426、0.451，均P＜0.001)、PCT(r=0.450、0.444、0.455，均   P＜0.001)以及预后(r=0.521、0.502、0.504，P＜0.001)均呈正相关。 结论  血清MIP-1α、YKL-40、NLRP3与维持性血液透析患者的导管相关性感染及预后具有一定相关性。

关键词: 维持性血液透析, 巨噬细胞炎性蛋白-1α, 几丁质酶-3样蛋白1, 含pyrin结构域的NOD样受体3, 导管相关性感染, 预后

Abstract: Objective  To investigate the correlation of serum levels of macrophage inflammatory protein-1α (MIP-1α), chitinase-3-like protein 1 (YKL-40), and NOD like receptor family pyrin domain-containing protein 3 (NLRP3) with catheter-related infections and prognosis in maintenance hemodialysis (MHD) patients.  Methods A total of 296 MHD patients treated in Luzhou Hospital of Traditional Chinese Medicine from January 2020 to August 2024 were included in this study. They were divided into infected group (n=68) and uninfected group (n=228) based on the presence or absence of catheter infection. The catheter infection patients were further divided into good prognosis subgroup (n=42) or poor prognosis subgroup (n=26). ELISA was applied to detect serum levels of MIP-1α, YKL-40, and NLRP3. Clinical data were collected and analyzed. Multivariate logistic regression was applied to analyze the factors influencing prognosis. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of MIP-1α, YKL-40, and NLRP3 for prognosis. Pearson and Spearman methods were applied to analyze the correlation of MIP-1α, YKL-40 and NLRP3 with inflammatory factors and prognosis.  Results  Compared with the uninfected group, the infected group had obviously higher levels of serum MIP-1α, YKL-40, NLRP3, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and procalcitonin (PCT) (t=14.532, 14.561, 22.823, 28.495, 11.487 and 22.234 respectively; P<0.001). Dialysis duration (t=3.293, P=0.002), dialysis frequency (t=3.293, P=0.001), MIP-1α (t=8.410, P＜0.001), YKL-40 (t=7.432, P＜0.001), NLRP3 (t=7.511, P＜0.001), CRP (t=15.045, P＜0.001), TNF-α (t=3.694, P＜0.001) and PCT (t=4.007, P＜0.001) levels in the poor prognosis subgroup were obviously higher than those in the good prognosis subgroup. ROC curve showed that the AUC of combined use of MIP-1α, YKL-40 and NLRP3 levels for predicting prognosis was obviously higher than that of single use of MIP-1α (Z=2.101, P=0.036), YKL-40 (Z=2.610, P=0.009) or NLRP3 (Z=2.965, P=0.003). MIP-1α, YKL-40, and NLRP3 were positively correlated with the inflammatory factors of CRP (r=0.462, 0.466 and 0.472 respectively; P＜0.001), TNF-α (r=0.450, 0.444 and 0.455 respectively; P＜0.001), and PCT (r=0.521, 0.502 and 0.504 respectively; P＜0.001), and with prognosis (r=0.521, 0.502 and 0.504 respectively; P＜0.001).   Conclusion Serum MIP-1α, YKL-40 and NLRP3 levels correlate with catheter-related infections and prognosis in MHD patients.

Key words: Maintenance hemodialysis, Macrophage inflammatory protein-1α, Chitinase-3-like protein 1, NOD like receptor family pyrin domain-containing protein 3, Catheter-related infection, Prognosis

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