【摘要】目的探讨血清可溶性生长刺激基因表达蛋白2(growth ST imulation expressed gene 2，sST2)、腱糖蛋白C(C-Terminus，TN-C)水平与维持性血液透析(maintenance hemodialysis，MHD)患者并发心血管事件的关系。方法本研究纳入2016 年10 月～2019 年10 月新乡医学院第一附属医院收治的115 例MHD 患者，根据MHD 患者是否并发心血管事件分为发生心血管事件组(n=47)和未发生心血管事件组(n=68)，另纳入同期在新乡医学院第一附属医院体检的58 例健康志愿者作为对照组，收集MHD 患者入组时的临床资料，采用酶联免疫吸附法分别检测对照组和MHD 组血清sST2、TN-C 水平，采用多因素Logistic回归分析MHD 患者发生心血管事件的影响因素，绘制ROC 曲线评价各指标对MHD 患者发生心血管事件的预测价值。结果MHD 组患者血清sST2、TN-C 水平显著高于对照组，差异均具有统计学意义(t=30.357，P＜0.001；t=42.237，P＜0.001)。发生心血管事件组和未发生心血管事件组MHD 患者的性别、原发疾病、收缩压、总胆固醇(total cholesterol，TC)、高密度脂蛋白(high-density lipoprotein cholesterol，HDL-C)、低密度脂蛋白(low density lipoprotein cholesterol，LDL-C)、三酰甘油(triacylglycerol，TG)、血磷、血钙、血肌酐(serum creatinine，Scr)、左心室射血分数(left ventricular ejection fraction，LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter，LVDD)相比，差异无统计学意义(χ2=0.096, P=0.757；χ2=0.961, P=0.327；t=1.456, P=0.074；t=0.850, P=0.199；t=0.566, P=0.286；t=0.744,P=0.229；t=1.494, P=0.069；t=1.245, P=0.108；t=0.798, P=0.213；t=1.641, P=0.052；t=0.695, P= 0.244)，但发生心血管事件组患者的年龄、透析时间、C-反应蛋白(C-reactive protein，CRP)、血尿酸(uric acid，UA)、白蛋白(albumin，ALB)、sST2、TN-C 明显高于未发生心血管事件组，差异有统计学意义(χ2=4.865, P=0.027；t=15.078, P＜0.001；t=9.285, P＜0.001；t=17.549, P＜0.001；t=4.213，P＜0.001；t=18.337，P＜0.001；t=16.585，P＜0.001)。多因素Logistic 回归分析结果显示，年龄、透析时间、sST2、TN-C 是MHD 患者发生心血管事件的独立危险因素(OR=2.235，95% CI:1.215～4.102, P=0.015；OR=4.251, 95% CI: 1.025～4.305, P=0.038；OR=6.560, 95% CI:1.059～2.300, P=0.024；OR=5.208，95% CI: 1.043～1.397，P=0.013)。ROC 曲线分析结果显示，血清sST2、TN-C 水平预测MHD 患者发生心血管事件的AUC 分别为0.813、0.786，灵敏度、特异度分别为78.62% 、73.41% 和76.30% 、70.72%。结论MHD 患者血清sST2、TN-C 水平明显升高，两者均是MHD 患者并发心血管事件的影响因素，且对MHD患者并发心血管事件具有一定的预测价值。
【Abstract】Objective To investigate the relationship between the serum levels of soluble growth stimulation expressed gene 2 (ST2) and tenascin-C (TN-C) and the cardiovascular events in maintenance hemodialysis (MHD) patients. Method This study enrolled 115 MHD patients admitted to the First Affiliated Hospital of Xinxiang Medical College from October 2016 to October 2019. According to the presence or absence of cardiovascular events, they were divided into two groups: cardiovascular event group (n=47) and non-cardiovascular event group (n=68). In addition, 58 healthy volunteers in the First Affiliated Hospital of Xinxiang Medical College were recruited as the control group. Clinical data of the patients were collected. Serum ST2 and TN-C levels of the patients and healthy controls were assayed by ELISA. Multivariate logistic regression was used to analyze the influencing factors for cardiovascular events in MHD patients. ROC curve was used to evaluate the predictive value of every index for cardiovascular events in MHD patients. Results Serum ST2 and TN-C levels were significantly higher in MHD group than in control group (t=30.357 and 42.237 respectively,P<0.001). Gender, primary disease, systolic blood pressure, total cholesterol, high-density lipoproteins, low-density lipoproteins, triacylglycerol, blood phosphorus, blood calcium, serum creatinine, left ventricular ejection fraction and left ventricular end diastolic diameter had no statistical significances between cardiovascular
event group and non-cardiovascular event group (χ2=0.096，P=0.757; χ2=0.961, P=0.327; t=1.456，P=0.074; t=0.850, P=0.199; t=0.566, P=0.286; t=0.744, P=0.229; t=1.494, P=0.069; t=1.245, P=0.108; t=0.798, P=0.213; t=1.641, P= 0.052; t=0.695, P=0.244), but age (χ2=4.865, P=0.027), dialysis time(t=15.078,P＜0.001), C-reaction protein (t=9.285, P＜0.001), uric acid (t=17.549, P＜0.001), albumin (t=4.213, P＜0.001), ST2 (t=18.337, P＜0.001) and TN-C (t=16.585, P＜0.001) were significantly higher in cardiovascular event group than in non- cardiovascular event group. Multivariate logistic regression analysis showed that age (OR=2.235, 95% CI: 1.215～4.102, P=0.015), dialysis time (OR=4.251, 95% CI: 1.025～4.305, P=0.038), ST2 (OR=6.560, 95% CI: 1.059～2.300, P=0.024) and TN-C (OR=5.208, 95% CI: 1.043～1.397, P=0.013)
were the independent risk factors for cardiovascular events in MHD patients. ROC curve showed that the AUC for predicting cardiovascular events using ST2 and TN-C levels were 0.813 and 0.786 respectively, the sensitivities were 78.62% and 76.30% respectively, and the specificities were 73.41% and 70.72% respectively. Conclusion Serum ST2 and TN-C levels increased significantly in MHD patients. Higher serum ST2 and TN-C levels were the influencing factors for cardiovascular events in MHD patients, and also had predictive value for cardiovascular events in MHD patients.
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