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投稿时间：2024-11-05 网络发布日期：2025-07-21
投稿时间：2024-11-05 网络发布日期：2025-07-21
中文摘要: 目的 分析慢性肾衰竭（CRF）维持性血液透析患者血清中同型半胱氨酸（Hcy）、甲状旁腺激素（PTH）和β2微球蛋白(β2-MG）水平变化对患者的预后价值。方法 回顾性分析安徽省第二人民医院2022年3月至2024年3月收治的180例CRF维持性血液透析患者的临床资料，根据其预后情况分为预后良好组（n=138例）和预后不良组（n=42例），对比两组患者的临床资料及实验室指标，包括血浆总胆固醇（TC）、三酰甘油（TG）、血红蛋白（Hb）及血清超敏C反应蛋白（hs-CRP）、白细胞（WBC）、中性粒细胞计数（NEUT）、Hcy、PTH、β2-MG。应用二元logistic回归模型分析CRF维持性血液透析患者预后影响因素，绘制受试者工作特征（ROC）曲线分析实验室指标对患者预后的预测价值。结果 预后良好组患者的年龄小于预后不良组，透析龄短于预后不良组，血清hs-CRP、Hcy、PTH、β2-MG水平均低于预后不良组，差异有统计学意义（P<0.05）。二元logistic回归分析结果显示，年龄≥65岁，透析龄≥10个月，高水平hs-CRP、Hcy、PTH、β2-MG是导致CRF维持性血液透析患者预后不良的危险因素（P<0.05）。ROC结果显示，血清Hcy、PTH、β2-MG水平及三者联合预测CRF维持性血液透析患者预后的AUC分别为0.884、0.885、0.867、0.893，敏感度分别为0.810、0.833、0.714、0.690，特异度分别为0.812、0.855、0.928、0.978，预测效能均较高。结论 CRF维持性血液透析患者预后受年龄、透析龄、血清hs-CRP、Hcy、PTH、β2-MG水平的影响，临床可通过检测血清Hcy、PTH、β2-MG水平变化预测患者预后。
Abstract:Objective To analyze the prognostic value of changes in serum levels of homocysteine（Hcy），parathyroid hormone（PTH），and β2-microglobulin(β2-MG）inpatients with chronic renal failure（CRF）undergoing maintenance hemodialysis. Methods A retrospective analysis was conducted on the clinical data of 180 CRF patients undergoing maintenance hemodialysis at Anhui No.2 Provincial People's Hospital from March 2022 to March 2024. Based on prognosis，the patients were divided into a good prognosis group（n= 138）and a poor prognosis group（n=42）. Clinical data and laboratory indicators，including plasma total cholesterol（TC），triglycerides（TG），hemoglobin（Hb），serum high-sensitivity C-reactive protein（hs-CRP），white blood cell count（WBC），neutrophil count（NEUT），Hcy，PTH， and β2-MG，were compared between the two groups. Binary logistic regression was used to analyze the factors influencing prognosis in CRF patients undergoing maintenance hemodialysis. Receiver operating characteristic（ROC） curves were plotted to evaluate the predictive value of laboratory indicators for patient prognosis.Results The good prognosis group was younger and had a shorter dialysis duration than the poor prognosis group，with lower serum levels of hs-CRP，Hcy，PTH，and β2-MG（P<0.05）. Binary logistic regression analysis showed that age ≥65 years，dialysis duration ≥10 months，and high levels of hs-CRP，Hcy，PTH，and β2-MG were risk factors for poor prognosis in CRF patients undergoing maintenance hemodialysis（P<0.05）. ROC analysis revealed that the AUC for serum Hcy，PTH，β2-MG ，and their combination in predicting prognosis were 0.884，0.885，0.867，and 0.893，respectively ，with sensitivities of 0.810，0.833，0.714，and 0.690，and specificities of 0.812，0.855，0.928，and 0.978，indicating high predictive efficacy. Conclusion The prognosis of CRF patients undergoing maintenance hemodialysis is influenced by age，dialysis duration，and serum levels of hs-CRP，Hcy，PTH，and β2-MG. Clinical monitoring of serum Hcy，PTH， and β2-MG levels can help predict patient prognosis.
keywords: Chronic renal failure Hemodialysis Serum homocysteine Parathyroid hormone β2-microglobulin Prognosis
文章编号： 中图分类号：R541.7 文献标志码：A
基金项目:
附件
| Author Name | Affiliation |
| LI Min，ZHANG Yuqin，ZHANG Hongxu | Department of Nephrology,Anhui No.2 Provincial People's Hospital,Hefei,Anhui 230041,China |
引用文本：
李敏，张育琴，张洪旭.慢性肾衰竭维持性血液透析患者血清Hcy、PTH、β2⁃MG水平及其临床意义[J].中国临床研究,2025,38(7):1069-1073.
李敏，张育琴，张洪旭.慢性肾衰竭维持性血液透析患者血清Hcy、PTH、β2⁃MG水平及其临床意义[J].中国临床研究,2025,38(7):1069-1073.