摘要
目的 研究血清4-羟基壬烯醛(4-Hydroxynonenal，4-HNE)联合载脂蛋白B(apolipoprotein B，ApoB)对慢性肾脏病(chronic kidney disease，CKD)3～4期糖尿病肾脏病(diabetic kidney disease，DKD)患者进展至终末期肾病(end-stage renal disease，ESRD)的预测价值。 方法 选取2021年1月─2023年3月收治的CKD G3～4 DKD患者126例，根据2年是否进展至ESRD分为ESRD组(n=46)和对照组(n=80)。比较2组一般资料、生化指标及血清4-HNE，采用二元Logistic回归模型分析CKD G3～4DKD进展为ESRD的影响因素，采用受试者工作特征(receiver operating characteristic，ROC)曲线分析临床指标的预测价值。 结果 ESRD组血肌酐、血尿素氮、载脂蛋白B(ApoB)、4-HNE水平高于对照组(t/Z/F /χ2=2.594、3.313、5.945、8.539，P=0.011、0.001、＜0.001、＜0.001)。Logistic回归分析结果显示：ApoB(OR=2813.365，95%CI：13.184～600349.625)、4-HNE(OR=23.923，95% CI:6.236～91.777)是CKD G3～4 DKD患者2年内进展至ESRD的影响因素。ApoB、4-HNE单独及联合预测CKD G3～4 DKD进展至ESRD的曲线下面积(area under the curve，AUC)分别为0.866、0.796、0.902，联合预测AUC高于二者单独预测(Z=4.723、5.691，P=0.021、0.013)。 结论 血清4-HNE和ApoB水平升高是CKD G3～4 DKD进展为ESRD的影响因素，联合检测血清4-HNE和ApoB对CKD G 3～4DKD患者2年内进展至ESRD具有较好的预测价值。
Abstract
Objective To investigate the predictive value of serum 4-hydroxynonenal (4-HNE) combined with apolipoprotein B (ApoB) for the progression to end-stage renal disease (ESRD) in chronic kidney disease (CKD) stage 3-4 patients with diabetic kidney disease (DKD). Methods A total of 126 CKD3-4 patients with DKD admitted from January 2021 to March 2023 were selected. They were divided into an ESRD group (n=46) and a control group (Con group, n=80) based on whether they progressed to ESRD within two years. The general data, biochemical indicators and serum 4-HNE were compared between the two groups. Binary Logistic regression model was used to analyze the influencing factors for the progression of CKD3～4 DKD to ESRD, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of clinical indicators. Results The levels of serum creatinine, blood urea nitrogen, apolipoprotein B (ApoB) and 4-HNE in the ESRD group were higher than those in the Con group (t/Z/F/χ²=2.594,3.313,5.945,8.539;P=0.011,0.001, <0.001, <0.001). Logistic regression analysis showed that ApoB (OR=2813.365, 95%CI: 13.184～600349.625) and 4-HNE (OR=23.923, 95%CI:6.236～91.777) were factors influencing the progression to ESRD within two years in patients with CKD G3～4 DKD. The area under the curve (AUC) of ApoB, 4-HNE, and their combination for predicting progression to ESRD was 0.866, 0.796, and 0.902, respectively, with the combined prediction showing a higher AUC than either indicator alone (Z=4.723,5.691;P=0.021,0.013). Conclusion Elevated serum 4-HNE and ApoB levels are influencing factors for the progression from CKD G3～4 DKD to ESRD. Combined detection of serum 4-HNE and ApoB has good predictive value for progression to ESRD within two years in patients with CKD G3～4 DKD.
关键词
糖尿病肾脏疾病 /
终末期肾病 /
4-羟基壬烯醛 /
载脂蛋白B
Key words
Diabetic kidney disease /
End-stage renal disease /
4-Hydroxynonenal /
Apolipoprotein B
韩小丽 赵 琦 董 娟 赵锦纹 蒋秀峰 卫志锋 刘翠兰.
血清4-羟基壬烯醛联合载脂蛋白B预测慢性肾脏病3～4期糖尿病肾脏病患者进展至终末期肾病的研究[J]. 中国血液净化. 2026, 25(05): 397-410 https://doi.org/0.3969/j.issn.1671-4091.2026.05.007
HAN Xiao-li, ZHAO Qi, DONG Juan, ZHAO Jin-wen, JIANG Xiu-feng, WEI Zhi-feng, LIU Cui-lan.
Prediction of progression to end-stage renal disease in patients with stage 3-4 chronic kidney disease with diabetic kidney disease by serum 4-HNE combined with ApoB[J]. Chinese Journal of Blood Purification. 2026, 25(05): 397-410 https://doi.org/0.3969/j.issn.1671-4091.2026.05.007
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基金
张家口市科学技术局2024年市级科技计划(2421067D)
