TNFR1、TNFR2 预测维持性血液透析患者预后的价值

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摘要目的探讨肿瘤坏死因子受体1（TNFR1）和肿瘤坏死因子受体2（TNFR2）预测维持性血液透析（MHD）患者全因死亡和心血管死亡风险的价值。方法前瞻性随访2019 年3 月1 日至4 月1 日福州市第一医院血液净化中心的300 例MHD 患者2 年，按照终点存活和死亡分为存活组（245 例）和死亡组（55 例）。收集患者基线资料，采用双抗体夹心ABC-ELISA 法测定TNFRl、TNFR2，观察的终点事件为患者全因死亡及心血管死亡。采用Cox 回归分析法分析患者全因死亡、心血管死亡的独立危险因素。采用受试者工作特征（ROC）曲线及约登指数评判TNFR1、TNFR2 对MHD 患者全因死亡、心血管死亡的预测价值。结果死亡组的年龄大于存活组，透析时间长于存活组，收缩压、TNFR1、TNFR2 水平高于存活组，白蛋白水平低于存活组，差异有统计学意义（P＜0.05）。 300 例MHD 患者中，有55 例（18.33%）患者死亡，其中心血管疾病死亡20 例（36.36%）。多变量Cox 回归分析结果显示，TNFR1（β=0.018，OR=1.018，95%CI=11.015～1.021）、TNFR2（β=0.007，OR=1.007，95%CI=1.005～1.009）是 MHD 患者全因死亡的独立危险因素（P＜0.01）；TNFR1（β=0.016，OR=1.016，95%CI=1.011～1.021）、TNFR2（β=0.007，OR=1.007，95%CI=1.004～1.011）是 MHD 患者心血管死亡的独立危险因素（P＜0.01）。 TNFR1、TNFR2 预测 MHD 患者全因死亡的 AUC 分别为 0.970、0.938，预测心血管死亡的 AUC 分别为 0.905、0.881。结论 TNFR1、TNFR2 浓度升高与MHD 患者预后密切相关，对MHD 患者预后的判断具有重要价值。

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	钟晓容
	杨枫

关键词 ：肿瘤坏死因子受体1, 肿瘤坏死因子受体2, 血液透析, 预后

Abstract：Objective To investigate the value of tumor necrosis factor receptor 1 (TNFR1) and tumor necrosis factor receptor 2 (TNFR2) in predicting the risk of all-cause death and cardiovascular death in maintenance hemodialysis(MHD) patients. Methods A total of 300 MHD patients in the Blood Purification Center of Fuzhou First Hospital from March 1 to April 1, 2019 were prospectively followed up for 2 years. According to the endpoint survival and death, they were diveded into the survival group (245 cases) and the death group (55 cases). The baseline data were collected.TNFR1 and TNFR2 were measured by double antibody sandwich ABC-ELISA. The end points events were all-cause death and cardiovascular deaths. Cox regression analysis was used to analyze the independent risk factors of all-cause mortality and cardiovascular mortality. Receiver operating characteristic (ROC) curve and Youden index were used to evaluate the predictive value of TNFR1 and TNFR2 on all-cause death and cardiovascular death in MHD patients.Results The age of the death group was older than that of the survival group, the dialysis time of the death group was longer than that of the survival group, the levels of systolic blood pressure, TNFR1 and TNFR2 of the death group were higher than those of the survival group, and the level of albumin of the death group was lower than that of the survival group, the differences were statistically significant (P＜0.05). Among the 300 MHD patients, 55 cases (18.33%) died,included 20 (36.36%) from cardiovascular disease. Multivariate Cox regression analysis showed that TNFR1 (β=0.018,OR=1.018, 95%CI=11.015-1.021), TNFR2 (β=0.007, OR=1.007, 95%CI=1.005-1.009) were independent risk factors for all-cause death in MHD patients (P＜0.01); TNFR1 (β=0.016, OR=1.016, 95%CI=1.011-1.021), TNFR2 (β=0.007,OR=1.007, 95%CI=1.004-1.011) were independent risk factors for cardiovascular death in MHD patients (P＜0.01). The AUC of TNFR1 and TNFR2 predicting all-cause death in MHD patients were 0.970 and 0.938, respectively, and the AUC predicting cardiovascular death were 0.905 and 0.881, respectively. Conclusion The elevated concentrations of TNFR1 and TNFR2 are closely related to the prognosis of MHD patients, and which are of great value in judging the prognosis of MHD patients

Key words： Tumor necrosis factor receptor 1 Tumor necrosis factor receptor 2 Hemodialysis Prognosis

基金资助:福建省福州市科技计划项目（2019-S-71）

作者简介: 钟晓容（1982-）,女，福建古田人，硕士，研究方向：慢性肾脏病学

引用本文:

钟晓容;杨枫. TNFR1、TNFR2 预测维持性血液透析患者预后的价值[J]. 中国当代医药, 2021, 28(34): 94-97.
ZHONG Xiao-rong; YANG Feng. Prognostic value of TNFR1 and TNFR2 in predicting of patients with maintenance hemodialysis. 中国当代医药, 2021, 28(34): 94-97.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I34/94

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