文章摘要

单核细胞计数、单核细胞/高密度脂蛋白比值对维持性血液透析患者腹主动脉钙化的预测价值

作者: 1周巧, 1周自英, 1滕洁, 2冯锦红, 2尹忠诚, 2张颖
1 徐州医科大学临床学院,江苏 徐州 221004
2 徐州医科大学附属医院肾内科,江苏 徐州 221006
通讯: 张颖 Email: 2540122360@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.12.009

摘要

目的:探讨单核细胞计数、单核细胞/高密度脂蛋白比值(monocyte to high density lipoprotein ratio,MHR)与维持性血液透析(maintenance hemodialysis,MHD)患者血管钙化的关系。方法:本研究为回顾性研究,纳入2018年10月至2019年10月在徐州医科大学附属医院血液净化中心行规律血液透析治疗的77例患者,使用腹部侧位平片检测腹主动脉钙化(abdominal aortic calcification,AAC)情况,并以此为依据分成腹主动脉钙化组及腹主动脉非钙化组,腹主动脉钙化组根据钙化评分,又分为腹主动脉钙化轻中度组和重度组,采用Spearman相关分析、ROC曲线分析探讨MHR与腹主动脉钙化及腹主动脉钙化严重程度的关系。结果:共纳入MHD患者77例,其中发生腹主动脉钙化患者39例,轻中度钙化患者28例,重度钙化患者11例;腹主动脉钙化组与腹主动脉非钙化组患者在年龄、单核细胞计数、血清白蛋白、MHR与甲状旁腺激素(parathyroid hormone,PTH),合并高血压、合并心血管疾病(cardiovascular diseases,CVD)、使用活性维生素D制剂的差异均有统计学意义(P<0.05),其中单核细胞计数、MHR与腹主动脉钙化呈正相关(r=0.389,r=0.377,P<0.05),轻中度腹主动脉钙化组的MHR值低于重度腹主动脉钙化组(0.40±0.18 vs 0.62±0.31,P<0.05),MHR与腹主动脉钙化严重程度有相关性(r=0.359,P=0.025)。单核细胞计数预测腹主动脉钙化的ROC曲线下面积为0.725(P=0.001),敏感性64.1%,特异性73.7%,MHR预测腹主动脉钙化的ROC曲线下面积为0.718(P=0.001),敏感性46.2%,特异性89.5%。结论:维持性血液透析患者的腹主动脉钙化发生率较高,单核细胞计数、MHR与腹主动脉钙化相关,且MHR与腹主动脉钙化严重程度相关,可用于以预测腹主动脉钙化的发生。
关键词: 血液透析;单核细胞计数;单核细胞/高密度脂蛋白比值;血管钙化

Predictive value of monocytes count and monocyte to high-density lipoprotein ratio for abdominal aortic calcification in maintenance hemodialysis patients

Authors: 1ZHOU Qiao, 1ZHOU Ziyin, 1TENG Jie, 2FENG Jinhong, 2YIN Zhongcheng, 2ZHANG Ying
1 Clinical Medical College, Xuzhou Medical University, Xuzhou Jiangsu 221004, China
2 Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu 221006, China

CorrespondingAuthor: ZHANG Ying Email: 2540122360@qq.com

Abstract

Objective: To explore the association of monocyte count, monocyte to high-density lipoprotein ratio (MHR) and vascular calcification in patients with maintenance hemodialysis (MHD). Methods: This study is a retrospective study. A total of 77 patients who underwent regular hemodialysis at the Blood Purification Center of the Affiliated Hospital of Xuzhou Medical University from October 2018 to October 2019 were determined abdominal aortic calcification (AAC) using abdominal plain radiographs. According to the results of this examination, patients were divided into an abdominal aortic calcification group and an abdominal aortic non-calcified group, then abdominal aortic calcification group was divided into abdominal aortic calcification mild and moderate group and severe group according to calcification score. The relationship between MHR and abdominal aortic calcification and the severity of abdominal aortic calcification was studied by Spearman correlation analysis and ROC curve analysis. Results: A total of 77 MHD patients were included in this study, including 39 cases of abdominal aortic calcification, 28 cases of mild to moderate calcification, 11 cases of severe calcification. In terms of age, monocyte count, serum albumin, MHR, parathyroid hormone (PTH), hypertension, cardiovascular disease, and the use of active vitamin D preparations was statistically significant (P<0.05). Monocytes and MHR were positively correlated with abdominal aortic calcification (r=0.389, r=0.377, P<0.05). The MHR value in the mild to moderate abdominal aortic calcification group was lower than that in the severe abdominal aortic calcification group (0.40±0.18 vs 0.62±0.31, P<0.05), and MHR was correlated with the severity of abdominal aortic calcification (r=0.359, P=0.025). The area under ROC curve for monocytes was 0.725 in abdominal aortic calcification (P=0.001), sensitivity was 64.1%, and specificity was 73.7%. The area under ROC curve for MHR was 0.718 in abdominal aortic calcification (P=0.001), sensitivity was 46.2%, and specificity was 89.5%. Conclusion: The incidence of abdominal aortic calcification is higher in patients with maintenance hemodialysis. Monocytes and MHR are associated with abdominal aortic calcification and MHR is related to the severity of abdominal aortic calcification, which can predict the occurrence of abdominal aortic calcification.
Keywords: maintenance hemodialysis; monocyte count; monocyte to high density lipoprotein ratio; vascular calcification