可溶性血栓调节蛋白检测对慢性肾脏病患者心血管并发症的预测价值

摘要：目的 观察慢性肾脏病（ＣＫＤ）患者血清内皮细胞损伤标志物可溶性血栓调节蛋白（ ｓＴＭ）水平，探讨 ｓＴＭ 检测对 ＣＫＤ 患者的临床价值。 方法 选取 ２０２０ 年 ２ 月至 ２０２１ 年 １１ 月南京鼓楼医院肾脏科确诊的 １１５ 例 ＣＫＤ 患者为研究对象，根据肾 功能状态分肾功能正常组（３１ 例）、肾功能不全组（３７ 例）、肾功能衰竭组（４７ 例），收集患者临床一般资料，包括性别、年龄、心 血管并发症；收集患者相关参数包括肾小球滤过率（ｅＧＦＲ）、２４ ｈ 尿蛋白、尿蛋白／ 尿肌酐、血尿素、血肌酐、血清清蛋白、血红蛋 白；采用发光免疫分析法测定血清 ｓＴＭ 水平并分析其在不同肾功能下水平差异，统计不同肾功能状态下心血管并发症患病情 况；采用 Ｓｐｅａｒｍａｎ 相关分析 ｓＴＭ 与 ＣＫＤ 实验室参数的相关性；采用 ＲＯＣ 曲线分析 ｓＴＭ 对 ＣＫＤ 患者伴发心血管疾病的预测 价值。 结果 随着肾功能下降，ｓＴＭ 水平逐渐升高，ＣＫＤ 患者心血管并发症逐渐增多（Ｐ＜０．０５）。 ｓＴＭ 水平与血肌酐、血尿素 呈正相关（ｒ 分别 ０．７７８、０．６４６，Ｐ＜０．００１），与 ｅＧＦＲ、Ｈｂ 呈负相关（ ｒ 分别为－０．７６１、－０．６００，Ｐ＜０．００１）。 ＲＯＣ 曲线分析 ｓＴＭ 对 ＣＫＤ 患者心血管疾病的预测价值，ＡＵＣ ＲＯＣ为 ０．９２７（Ｐ＜０．０５），当截断值为 １９．４ ＩＵ／ ｍＬ 时，敏感性为 ８４．９％，特异性为９０．５％。 结论 随着 ＣＫＤ 患者肾功能下降，体内多种病理因素促进血管内皮细胞持续损伤，ｓＴＭ 作为评估 ＣＫＤ 患者血管内皮损伤程 度指标，对 ＣＫＤ 患者伴发心血管疾病有较高的预测价值，且与肾脏损害程度有很好的相关性。

Relationship between uremic toxin and vascular endothelial cell injury in patients with chronic kidney disease

Objective To detect the level of soluble thrombomodulin (sTM), a marker of endothelial cell injury in serum of patients with chronic kidney disease (CKD) under different renal function conditions, and analyze its relationship with CKD laboratory related parameters, so as to explore the relationship between uremic toxin and the degree of vascular endothelial cell injury in patients with CKD. Methods 115 patients with CKD diagnosed in the nephrology department of Nanjing Gulou Hospital from February 2020 to November 2021 were selected as the research object. According to the status of renal function, they were divided into three groups: 31 cases in the normal renal function group, 37 cases in the renal insufficiency group and 47 cases in the renal failure group.The level of serum sTM was measured by luminescence immunoassay, and the general clinical data including gender, age and cardiovascular complications were collected; The relevant parameters of patients were collected, including glomerular filtration rate (eGFR), 24h urinary protein, urinary protein / urinary creatinine (UACR), blood urea nitrogen (BUN), blood creatinine (Scr), albumin and hemoglobin (Hb).The prevalence of cardiovascular complications in different renal function states was counted; Analyze the difference of sTM level under different renal function; Spearman correlation was used to analyze the correlation between sTM and CKD laboratory parameters. Results With the decline of renal function, the cardiovascular complications of CKD patients increased gradually, and the level of sTM also increased gradually (P < 0.05). The level of sTM was positively correlated with blood creatinine, blood urea nitrogen, urinary protein / urinary creatinine and 24h urinary protein (r 0.778, 0.646, 0.395 and 0.362, P < 0.001 respectively), and negatively correlated with eGFR, Hb and serum albumin (r -0.761, -0.600 and -0.481, P < 0.001 respectively). Conclusion With the decline of renal function in patients with CKD, uremic toxins gradually increase, resulting in continuous damage to vascular endothelial cells. Therefore, it is suggested that sTM is a good index to evaluate the degree of vascular endothelial damage in patients with CKD, and has a good correlation with the degree of renal damage.