河北医科大学学报 ›› 2024, Vol. 45 ›› Issue (9): 1079-1084.doi: 10.3969/j.issn.1007-3205.2024.09.017

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外周血Klotho水平对超声引导下PTA术后AVF再狭窄的预测价值

  

  1. 1.邢台医学高等专科学校第二附属医院肾内科，河北 邢台 054000；2.邢台医学高等专科学校第二附属医院功能科，
    河北 邢台 054000；3.邢台医学高等专科学校第二附属医院医务科，河北 邢台 054000

  • 出版日期:2024-09-25 发布日期:2024-10-09
  • 作者简介:武亮（1983-），男，河北邢台人，邢台医学高等专科学校第二附属医院副主任医师，医学硕士，从事肾脏疾病诊治研究。
  • 基金资助:
    邢台市重点研发计划项目(2022ZC241)

The predictive value of Klotho level in peripheral blood for AVF restenosis after ultrasound-guided PTA

  1. 1.Department of Nephrology, the Second Affiliated Hospital of Xingtai Medical College, Hebei Province, 
    Xingtai 054000, China; 2.Department of Function, the Second Affiliated Hospital of Xingtai 
    Medical College, Hebei Province, Xingtai 054000, China; 3.Department of Medical 
    Administration, the Second Affiliated Hospital of Xingtai Medical College, 
    Hebei Province, Xingtai 054000, China

  • Online:2024-09-25 Published:2024-10-09

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摘要： 目的 探讨外周血Klotho蛋白对终末期肾脏病(end stage renal disease，ESRD)患者经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)后发生动静脉内瘘(arteriovenous fistula,AVF)再狭窄的预测价值。
方法 选取邢台医学高等专科学校第二附属医院行PTA手术的240例ESRD患者为研究对象，随访截止时间为2022年12月，根据是否发生AVF再狭窄分为狭窄组和非狭窄组。检测并比较2组的外周血Klotho水平，分析外周血Klotho与AVF再狭窄的相关性和预测价值，并收集2组的临床资料，进行单因素分析和多元Logistic回归分析，探究VAF再狭窄的独立危险因素。
结果 狭窄组外周血Klotho显著低于非狭窄组，差异有统计学意义(P＜0.05)，外周血Klotho与AVF再狭窄呈负相关关系（r=-0.039,P＜0.001），外周血Klotho对AVF再狭窄预测的ROC曲线下面积为0.866（95%CI：0.823~0.909），截断值1.35 ng/L。多元Logistic回归分析表明，年龄≥75岁（OR=2.425,95%CI：1.054~5.579）、糖化血红蛋白≥6.5%（OR=2.570，95%CI：1.328~4.975）、血清白蛋白＜40 g/L（OR=3.105,95%CI：1.040~9.269）、钙磷乘积＞50 mmol/L（OR=3.804,95%CI：1.155~12.524）、Klotho蛋白＜1.35 ng/L（OR=2.863,95%CI：1.272~6.446）是ESRD患者PTA术后发生再狭窄的独立危险因素(P＜0.05)。
结论 外周血Klotho水平与ESRD患者PTA术后发生AVF再狭窄具有负相关性，具有较高的预测价值，外周血Klotho水平下降与高龄、糖化血红蛋白水平升高、血清白蛋白水平下降以及钙磷乘积升高是AVF再狭窄的独立危险因素。


关键词: 肾功能衰竭, 慢性, 经皮腔内血管成形术, 动静脉内瘘

Abstract: Objective To explore the predictive value of Klotho protein in peripheral blood for arteriovenous fistula (AVF) restenosis in patients with end-stage renal disease (ESRD) after percutaneous transluminal angioplasty (PTA). 
Methods A total of 240 ESRD patients undergoing PTA  in the Second Affiliated Hospital of Xingtai Medical College were selected as the research subjects. The follow-up deadline was December 2022, and they were divided into stenosis group and non-stenosis group based on occurrence of AVF restenosis. The peripheral blood Klotho levels of two groups were detected and compared, and the correlation between peripheral blood Klotho and AVF restenosis and predictive value of peripheral blood Klotho for AVF restenosis were analyzed.  Clinical data of the two groups were collected for univariate analysis and multiple logistic regression analysis to explore independent risk factors for VAF restenosis. 
Results The peripheral blood Klotho in the stenosis group was significantly lower than that in the non-stenosis group, with a significant difference (P＜0.05). There was a negative correlation between peripheral blood Klotho and AVF restenosis (r=-0.039, P＜0.001). The area under the receiver operating characteristic (ROC) of peripheral blood Klotho for predicting AVF restenosis was 0.866 (95%CI: 0.823-0.909), with a cutoff value of 1.35 ng/L. Multiple logistic regression analysis showed that age ≥ 75 years (OR=2.425, 95%CI: 1.054-5.579), glycated hemoglobin ≥ 6.5% (OR=2.570, 95%CI: 1.328-4.975), serum albumin ＜40 g/L (OR=3.105, 95%CI: 1.040-9.269), calcium phosphorus product ＞50 mmol/L (OR=3.804, 95%CI: 1.155-12.524), and Klotho protein ＜1.35 ng/L (OR=2.863, 95%CI: 1.272-6.446) were independent risk factors for postoperative restenosis in ESRD patients undergoing PTA (P＜0.05). 
Conclusion The level of peripheral blood Klotho has a negative correlation with the occurrence of AVF restenosis in ESRD patients after PTA, which has a high predictive value. The decrease in peripheral blood Klotho level, the advanced age, the increase in glycated hemoglobin level, the decrease in serum albumin level, and the increase in calcium phosphorus product are independent risk factors for AVF restenosis. 


Key words: kidney failure, chronic, percutaneous transluminal angioplasty, arteriovenous fistula

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