视黄醇结合蛋白 4 与血液透析患者动静脉瘘功能障碍的关系。

Association of Retinol-Binding Protein 4 with Arteriovenous Fistula Dysfunction in Hemodialysis Patients.

机构信息

Department of Nephrology, North Huashan Hospital Affiliated to Fudan University, Shanghai, China.

Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.

出版信息

Blood Purif. 2021;50(6):906-913. doi: 10.1159/000513418. Epub 2021 Feb 8.

DOI:10.1159/000513418

PMID:33556944

Abstract

BACKGROUND

Arteriovenous fistula (AVF) is the most common vascular access for patients undergoing hemodialysis (HD). Neointimal hyperplasia (NIH) might be a potential mechanism of AVF dysfunction. Retinol-binding protein 4 (RBP4) may play an important role in the pathogenesis of NIH. The aim of this study was to investigate whether AVF dysfunction is associated with serum concentrations of RBP4 in HD subjects.

METHODS

A cohort of 65 Chinese patients undergoing maintenance HD was recruited between November 2017 and June 2019. The serum concentrations of RBP4 of each patient were measured with the ELISA method. Multivariate logistic regression was used to analyze data on demographics, biochemical parameters, and serum RBP4 level to predict AVF dysfunction events. The cutoff for serum RBP4 level was derived from the highest score obtained on the Youden index. Survival data were analyzed with the Cox proportional hazards regression analysis and Kaplan-Meier method.

RESULTS

Higher serum RBP4 level was observed in patients with AVF dysfunction compared to those without AVF dysfunction events (174.3 vs. 168.4 mg/L, p = 0.001). The prevalence of AVF dysfunction events was greatly higher among the high RBP4 group (37.5 vs. 4.88%, p = 0.001). In univariate analysis, serum RBP4 level was statistically significantly associated with the risk of AVF dysfunction (OR = 1.015, 95% CI 1.002-1.030, p = 0.030). In multivariate analysis, each 1.0 mg/L increase in RBP4 level was associated with a 1.023-fold-increased risk of AVF dysfunction (95% CI for OR: 1.002-1.045; p = 0.032). The Kaplan-Meier survival analysis indicated that the incidence of AVF dysfunction events in the high RBP4 group was significantly higher than that in the low-RBP4 group (p = 0.0007). Multivariate Cox regressions demonstrated that RBP4 was an independent risk factor for AVF dysfunction events in HD patients (HR = 1.015, 95% CI 1.001-1.028, p = 0.033).

CONCLUSIONS

HD patients with higher serum RBP4 concentrations had a relevant higher incidence of arteriovenous dysfunction events. Serum RBP4 level was an independent risk factor for AVF dysfunction events in HD patients.

摘要

背景

动静脉瘘（AVF）是接受血液透析（HD）治疗的患者最常用的血管通路。内膜增生（NIH）可能是 AVF 功能障碍的潜在机制。视黄醇结合蛋白 4（RBP4）可能在 NIH 的发病机制中起重要作用。本研究旨在探讨 HD 患者血清 RBP4 浓度与 AVF 功能障碍之间的关系。

方法

2017 年 11 月至 2019 年 6 月期间，我们招募了 65 名中国维持性 HD 患者。采用 ELISA 法测定每位患者的血清 RBP4 浓度。采用多变量逻辑回归分析人口统计学、生化参数和血清 RBP4 水平数据，以预测 AVF 功能障碍事件。血清 RBP4 水平的截断值来自 Youden 指数获得的最高得分。采用 Cox 比例风险回归分析和 Kaplan-Meier 法分析生存数据。

结果

与无 AVF 功能障碍事件的患者相比，AVF 功能障碍患者的血清 RBP4 水平更高（174.3 与 168.4mg/L，p=0.001）。高 RBP4 组的 AVF 功能障碍事件发生率明显更高（37.5%与 4.88%，p=0.001）。单因素分析显示，血清 RBP4 水平与 AVF 功能障碍的风险显著相关（OR=1.015，95%CI 1.002-1.030，p=0.030）。多因素分析显示，RBP4 水平每增加 1.0mg/L，AVF 功能障碍的风险增加 1.023 倍（95%CI 比值比：1.002-1.045；p=0.032）。Kaplan-Meier 生存分析表明，高 RBP4 组的 AVF 功能障碍事件发生率明显高于低 RBP4 组（p=0.0007）。多因素 Cox 回归分析表明，RBP4 是 HD 患者 AVF 功能障碍事件的独立危险因素（HR=1.015，95%CI 1.001-1.028，p=0.033）。