血清HIF-1α和VEGF对维持性血液透析患者血管钙化的影响

戴荣; 韩姝; 谢伟楠; 王保家; 第加美

doi:10.16766/j.cnki.issn.1674-4152.004202

血清HIF-1α和VEGF对维持性血液透析患者血管钙化的影响

doi: 10.16766/j.cnki.issn.1674-4152.004202

1.
蚌埠医科大学研究生院, 安徽蚌埠 233030
2.
安徽理工大学第一附属医院肾内科, 安徽淮南 232007

基金项目:

安徽省卫生健康科研项目(重点项目) AHWJ2023A 10030

安徽理工大学医学专项培育项目(重点项目) YZ2023H1B004

详细信息

通讯作者:
第加美，E-mail：2562344375@qq.com

中图分类号: R692.5 R459.5
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出版历程
- 收稿日期: 2024-09-19

Effects of serum HIF-1α and VEGF on vascular calcification in patients with maintenance hemodialysis

1.
Graduate School of Bengbu Medical University, Bengbu, Anhui 233030, China

摘要

摘要: 目的探讨血清低氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)与维持性血液透析(MHD)患者血管钙化(VC)的关系，并评估其对VC的预测价值。方法选取2023年10月—2024年8月于安徽理工大学第一附属医院血液净化中心行MHD的101例慢性肾脏病(CKD)患者，采用腹部侧位X线平片评估患者VC情况。根据腹主动脉钙化积分(AACS)将其分为钙化组(59例)和非钙化组(42例)。比较2组患者血钙、血磷等临床资料及血清HIF-1α、VEGF水平；采用相关性分析研究HIF-1α、VEGF与AACS的相关性；采用多因素logistic回归分析研究MHD患者VC发生的影响因素；采用ROC曲线分析HIF-1α、VEGF水平对MHD患者发生VC的预测价值。结果钙化组年龄、透析龄、碱性磷酸酶、血钙、血磷、TC、HIF-1α、VEGF水平均高于非钙化组(P < 0.05)。相关性分析显示，HIF-1α、VEGF水平与AACS均呈正相关关系(P < 0.05)。多因素logistic回归分析显示, 年龄、血钙、血磷、HIF-1α、VEGF均为MHD患者发生VC的影响因素(P < 0.05)。HIF-1α、VEGF单独以及两者联合预测MHD患者发生VC的ROC曲线下面积分别为0.756(灵敏度47.5%，特异度97.6%)、0.777(灵敏度71.2%，特异度76.2%)、0.879(灵敏度83.1%，特异度83.3%)。结论年龄、血钙、血磷、HIF-1α及VEGF水平均为MHD患者发生AACS的影响因素，HIF-1α及VEGF与VC呈正相关关系，两者均对MHD患者发生VC有一定的预测价值，二者联合预测价值更高。
- 慢性肾脏病 /
- 维持性血液透析 /
- 血管钙化 /
- 低氧诱导因子-1α /
- 血管内皮生长因子
Abstract: Objective To investigate the relationship between serum hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), and vascular calcification (VC) in patients with maintenance hemodialysis (MHD), and to evaluate their predictive value for VC. Methods A total of 101 patients with chronic kidney disease (CKD) who underwent MHD in the Blood Purification Center of the First Affiliated Hospital of Anhui University of Science and Technology from October 2023 to August 2024 were enrolled. The patients ' VC was evaluated by abdominal lateral X-ray. According to the abdominal aortic calcification score (AACS), they were divided into a calcification group (59 cases) and a non-calcification group (42 cases). The clinical data, such as serum calcium and phosphorus, and serum HIF-1α and VEGF levels, were compared between the two groups. The correlation method was used to analyze the correlation between HIF-1α, VEGF, and AACS. Multivariate logistic regression was used to analyze the influencing factors of VC in MHD patients. The ROC curve was used to analyze the predictive value of HIF-1α and VEGF levels for VC in MHD patients. Results The age, dialysis age, alkaline phosphatase, serum calcium, serum phosphorus, TC, HIF-1α, and VEGF levels in the calcification group were higher than those in the non-calcification group (P < 0.05). Correlation analysis showed that the levels of HIF-1α and VEGF were positively correlated with AACS (P < 0.05). Multivariate logistic regression showed that age, serum calcium, serum phosphorus, HIF-1α, and VEGF were risk factors for VC in MHD patients (P < 0.05). The areas under the ROC curves of HIF-1α and VEGF alone and their combined prediction were 0.756 (sensitivity 47.5%, specificity 97.6%), 0.777 (sensitivity 71.2%, specificity 76.2%), and 0.879 (sensitivity 83.1%, specificity 83.3%), respectively. Conclusion Age, serum calcium, serum phosphorus, and levels of HIF-1α and VEGF are important influencing factors for the occurrence of VC in MHD patients. HIF-1α and VEGF are positively correlated with AACS. Both have certain predictive value for the occurrence of VC in MHD patients, and the combined predictive value is higher.
- Chronic kidney disease /
- Maintenance hemodialysis /
- Vascular calcification /
- Hypoxia-inducible factor-1α /
- Vascular endothelial growth factor
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图 1 血清HIF-1α、VEGF水平预测MHD患者VC发生的ROC曲线

Figure 1. ROC curves of serum HIF-1α and VEGF levels for predicting VC occurrence in MHD patients

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表 1 2组CKD患者一般资料比较

Table 1. Comparison of general data in CKD patients between two groups

项目	非钙化组(n=42)	钙化组(n=59)	统计量	P值
性别[例(%)]			0.632^a	0.426
男性	26(61.9)	41(69.5)
女性	16(38.1)	18(30.5)
年龄(x ±s, 岁)	48.24±10.11	63.05±10.31	7.174^b	< 0.001
体质量[M(P₂₅, P₇₅), kg]	64.75(57.30, 73.50)	63.70(55.75, 73.25)	-0.441^c	0.659
透析龄[M(P₂₅, P₇₅), 月]	38.50(14.00, 60.00)	51.00(24.50, 69.50)	-1.969^c	0.049
原发病种类[例(%)]			1.432^a	0.698
高血压肾病	6(14.3)	13(22.0)
糖尿病肾病	14(33.3)	20(33.9)
慢性肾小球肾炎	11(26.2)	11(18.6)
其他	11(26.2)	15(25.4)
收缩压(x ±s, mmHg)	144.19±21.12	144.12±22.67	0.016^b	0.987
舒张压(x ±s, mmHg)	80.67±10.07	75.03±13.14	2.332^b	0.022
注：^a为χ²值，^b为t值，^c为Z值。1 mmHg=0.133 kPa。

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表 2 2组CKD患者生化指标比较

Table 2. Comparison of biochemical indicators between the two groups of CKD patients

项目	非钙化组(n=42)	钙化组(n=59)	统计量	P值
Hb(x ±s, g/L)	113.00±13.88	109.39±17.68	1.103^a	0.273
碱性磷酸酶[M(P₂₅, P₇₅), U/L]	87.50(76.50, 104.00)	98.00(76.50, 120.50)	-1.978^b	0.048
BUN(x ±s, mmol/L)	40.52±10.96	44.77±13.30	1.701^a	0.092
肌酐(x ±s, μmol/L)	859.52±252.90	787.37±200.73	1.597^a	0.114
血钙[M(P₂₅, P₇₅), μmol/mL]	22.90(22.10, 23.50)	23.20(22.80, 24.20)	2.338^b	0.019
血镁(x ±s, mmol/L)	1.06±0.10	1.05±0.13	0.453^a	0.652
血磷(x ±s, μmmol/mL)	16.51±4.11	18.31±3.85	2.248^a	0.027
TG[M(P₂₅, P₇₅), mmol/L]	1.35(1.10, 2.30)	1.28(0.92, 2.05)	-0.696^b	0.486
TC(x ±s, mmol/L)	3.79±0.82	4.20±1.10	2.029^a	0.045
CRP[M(P₂₅, P₇₅), mg/L]	0.10(0.10, 2.05)	0.10(0.10, 0.10)	-0.179^b	0.858
胱抑素C(x ±s, mmol/L)	7.13±1.46	7.66±1.22	1.988^a	0.050
甲状旁腺激[M(P₂₅, P₇₅), pg/mL]	273.06(145.16, 415.99)	249.96(153.01, 392.45)	-0.386^b	0.700
注：^a为t值，^b为Z值。

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表 3 MHD患者VC发生影响因素的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of factors influencing VC occurrence in MHD patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.259	0.070	13.641	< 0.001	1.296	1.129~1.487
透析龄	0.015	0.015	1.041	0.307	1.015	0.986~1.044
碱性磷酸酶	0.013	0.017	0.588	0.443	1.013	0.980~1.047
血钙	1.042	0.454	5.275	0.022	2.836	1.165~6.902
血磷	0.238	0.112	4.531	0.033	1.268	1.019~1.578
TC	-0.625	0.471	1.759	0.185	0.535	0.212~1.348
HIF-1α	0.037	0.010	13.374	< 0.001	1.038	1.017~1.059
VEGF	0.050	0.019	6.846	0.009	1.051	1.013~1.091

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