2024 年第 1 期 第 19 卷

血清Krüppel样因子2和血管紧张素Ⅱ受体样1内源性配体13对血液透析患者自体动静脉内瘘狭窄的预测价值

Predictive value of serum Krüppel-like factor 2 and angiotensin Ⅱ receptor-like 1 endogenous ligand 13 in hemodialysis patients with autogenous arteriovenous endovascular fistula stenosis

作者：王明波1 倪晓娜1 朱琳2 喻珊珊1

英文作者：Wang Mingbo1 Ni Xiaona1 Zhu Lin2 Yu Shanshan1

单位：1山东省济南市人民医院肾病风湿科，济南271100；2山东省济南市人民医院血透室，济南271100

英文单位：1Department of Nephrology and Rheumatology Jinan City People′s Hospital Shandong Province Jinan 271100 China; 2Hemodialysis Room Jinan City People′s Hospital Shandong Province Jinan 271100 China

关键词：血液透析；自体动静脉内瘘狭窄；Krüppel样因子2；血管紧张素Ⅱ受体样1内源性配体13

英文关键词：Hemodialysis;Autologousarteriovenousendovascularfistulastenosis;Krüppel-likefactor2;AngiotensinⅡreceptor-like1endogenousligand13

• 摘要：

• 目的  探讨血清Krüppel样因子2（KLF2）、血管紧张素 Ⅱ 受体样1内源性配体13（Apelin-13）水平对血液透析患者自体动静脉内瘘（AVF）狭窄的预测价值。 方法  选取2018年6月至2022年12月山东省济南市人民医院收治的214例以AVF为血管通路的血液透析患者为血液透析组，另选取同期53例体检健康者为对照组。血液透析组患者根据是否伴有AVF狭窄分为狭窄组（37例）和非狭窄组（177例）。记录患者临床资料，采用酶联免疫吸附试验法检测血清KLF2、Apelin-13水平。通过多因素Logistic回归方法分析血液透析患者AVF狭窄的影响因素，采用受试者工作特征（ROC）曲线分析血清KLF2、Apelin-13水平对血液透析患者AVF狭窄的预测价值。 结果  血液透析组血清KLF2、Apelin-13水平均低于对照组（均P＜0.001）。狭窄组年龄、透析龄、透析中低血压比例、超滤率、低密度脂蛋白胆固醇水平均大于/长于/高于非狭窄组，体重指数、收缩压、KLF2、Apelin-13水平均低于非狭窄组（均P＜0.05）。多因素Logistic回归分析结果显示，透析龄延长、透析中低血压、超滤率增加为血液透析患者AVF狭窄的独立危险因素，体重指数增加、KLF2升高、Apelin-13升高为独立保护因素（均P＜0.05）。ROC曲线分析结果显示，血清KLF2、Apelin-13单独与联合预测血液透析患者AVF狭窄的曲线下面积分别为0.797、0.794、0.907，敏感度分别为54.05%、100.00%、91.89%，特异度分别为92.66%、50.85%、83.05%。 结论  血清KLF2、Apelin-13水平降低与血液透析患者AVF狭窄密切相关，可作为AVF狭窄的辅助预测指标。

• Objective  To investigate the predictive value of serum Krüppel-like factor 2 (KLF2) and angiotensin Ⅱ receptor-like 1 endogenous ligand 13 (Apelin-13) levels in autologous arteriovenous endovascular fistula (AVF) stenosis in hemodialysis patients. Methods  Totally 214 hemodialysis patients with AVF as vascular access admitted to Jinan City People′s Hospital, Shandong Province from June 2018 to December 2022 were selected as hemodialysis group. Another 53 physically healthy people were selected as control group during the same period. The hemodialysis group was divided into stenosis group (37 cases) and non-stenosis group (177 cases) according to whether they were accompanied by AVF stenosis. Clinical data of patients were recorded. Serum KLF2 and Apelin-13 levels were measured by enzyme-linked immunosorbent assay. Multivariate Logistic regression was used to analyze the factors influencing AVF stenosis in hemodialysis patients and the predictive value of serum KLF2 and Apelin-13 levels on AVF stenosis in hemodialysis patients was analyzed by receiver operating characteristic (ROC) curve. Results  Serum KLF2 and Apelin-13 levels were lower in the hemodialysis group than those in the control group (both P<0.001). The age, dialysis age, proportion of hypotension in dialysis, ultrafiltration rate and low-density lipoprotein cholesterol level in the stenosis group were greater/longer/higher than those in the non-stenosis group, and body mass index, systolic blood pressure, KLF2, Apelin-13 levels were lower than those in the non-stenosis group (all P<0.05). Multivariate Logistic regression analysis showed that extended dialysis age, hypotension in hemodialysis, and increased ultrafiltration rate were independent risk factors for AVF stenosis in hemodialysis patients, while increased body mass index, elevated KLF2, and elevated Apelin-13 were independent protective factors (all P<0.05). ROC curve analysis showed that the area under the curve for serum KLF2 and Apelin-13 levels alone and in combination to predict AVF stenosis in hemodialysis patients was 0.797, 0.794 and 0.907, with sensitivities of 54.05%, 100.00% and 91.89%, and specificities of 92.66%, 50.85% and 83.05%, respectively. Conclusion  Decreased serum KLF2 and Apelin-13 levels are closely associated with AVF stenosis in hemodialysis patients and can be used as auxiliary predictors of AVF stenosis.