【摘要】目的探讨组织蛋白酶K 水平与维持性血液透析(maintenance hemodialysis，MHD)患者心血管疾病(cardiovascular disease，CVD)死亡的关系。方法回顾性选择2017 年1 月～2019 年12 月连云港市第一人民医院血液净化中心96 例MHD 患者作为研究对象,另选择同期体检中心96 例健康人群作为对照。采用电化学发光法检测血清组织蛋白酶K 水平，采用Spearson 相关分析血清组织蛋白酶K 水平与临床病理特征及实验室指标的相关性，CVD 死亡的危险因素采用Logistic 回归分析。结果MHD 组患者血清组织蛋白酶K 水平为(280.75 ± 36.84)ng/L，高于健康对照组的(112.95 ± 20.14)ng/L(t=39.158，P＜0.001)。MHD 存活组患者血清组织蛋白酶K 水平为(224.56±38.95)ng/L，低于MHD 因CVD死亡组的(417.21±35.99)ng/L(t=23.273，P＜0.001)。MHD 患者血清组织蛋白酶K 水平与糖尿病史、白细胞计数呈负相关(r=-0.324，P=0.011；r=-0.311，P=0.009)，与甲状旁腺激素、碱性磷酸酶、C 反应蛋白呈正相关(r=0.411，P=0.002；r=0.487，P＜0.001；r=0.418，P=0.002)。多因素Logistic 回归分析显示，低血红蛋白水平、高组织蛋白酶K 水平是影响MHD 患者CVD 死亡的危险因素(OR=1.125, 95% CI：1.014～1.944, P=0.041；OR=2.012, 95% CI：1.411～6.254，P=0.003)。结论MHD 患者以及CVD 死亡患者血清组织蛋白酶K 水平显著升高，组织蛋白酶K 是MHD患者CVD 死亡危险因素标志物。
【Abstract】Objective To investigate the relationship between Cathepsin K level and cardiovascular disease (CVD) death in maintenance hemodialysis (MHD) patients. Methods From Jan 2017 to Dec 2019, 96 MHD patients in the blood purification center of Lianyungang first people's hospital were selected as the research objects (MHD group, n=96). Another 96 healthy people in the physical examination center were selected as the control group (healthy control group, n=96). The serum cathepsin K level was detected by electrochemiluminescence. The correlation between serum cathepsin K level and clinicopathological features and laboratory parameters was analyzed by Pearson correlation. The risk factors of CVD death were analyzed by logistic regression. Results The serum Cathepsin K level of MHD group was 280.75±36.84 ng/L, which was significantly higher than that in healthy control group (112.95±20.14 ng/L，t=39.158, P＜0.001). The serum Cathepsin K level of MHD survival group was 224.56±38.95 ng/L, which was significantly lower than that in CVD death group (417.21±35.99ng/L, t=23.273, P＜0.001). The serum Cathepsin K level was negatively correlated with diabetes and white blood cell count (r=-0.324, P=0.011; r=-0.311, P=0.009), and positively correlated with parathyroid hormone, alkaline phosphatase and C-reactive protein(r=0.411, P=0.002; r=0.487, P＜0.001; r=0.418, P=0.002). Low hemoglobin level and high Cathepsin K level were independent risk factors of CVD death in MHD patients (OR= 1.125, 95% CI:1.014~1.944, P=0.041; OR=2.012, 95% CI:1.411~6.254, P=0.003). Conclusion The serum Cathepsin K level is significantly increased in MHD patients and CVD death patients, and Cathepsin K is a potential biomarker of CVD death in MHD patients.
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