Abstract:

Objective　To analyze the value of serum homocysteine (Hcy) and fibroblast growth factor-23 (FGF-23) in the prediction of cardiovascular and cerebrovascular events in patients with uremia and hypertension treated with hemodialysis. Methods　A total of 98 patients with uremia and hypertension who underwent hemodialysis in Huangshi Hospital of Traditional Chinese Medicine from February 2019 to December 2022 were selected as the research objects, including 58 males and 40 females who were 53-76 (64.18±5.39) years old. The clinical data, such as serum Hcy and FGF-23, were collected. The patients were followed up for 1 year. The incidence of cardiovascular and cerebrovascular events in the patients during the follow-up period was statistically analyzed. The factors affecting the occurrence of cardiovascular and cerebrovascular events in the patients were analyzed by t and χ² tests and logistic regression analysis. The values of Hcy and FGF-23 in the prediction of the occurrence of cardiovascular and cerebrovascular events in the patients was analyzed by the receiver operating characteristic curves (ROC). Results　Among the 98 patients, 37 cases (37.76%) had cardiovascular and cerebrovascular events, and the remaining 61 cases (62.24%) did not have cardiovascular and cerebrovascular events. There were no statistical differences in gender, age, body mass index, smoking history, drinking history, heart rate, hypertension course, systolic and diastolic pressures, antihypertensive drugs, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, prealbumin, transferrin, urea nitrogen, creatinine, uric acid, alanine transaminase, gamma-glutamyltransferase, blood Ca and P, blood urea clearance index, parathyroid hormone, and left ventricular ejection fraction between the two groups (all P>0.05). The dialysis age, albumin, low density lipoprotein cholesterol, urinary albumin excretion rate, red blood cell distribution width, Hcy, and FGF-23 in the patients with cardiovascular and cerebrovascular events were higher than those in the patients with no cardiovascular and cerebrovascular events [(4.83±0.81) years vs. (4.39±0.58) years, (36.33±5.08) g/L vs. (32.66±5.39) g/L, (3.59±0.75) mmol/L vs. (3.25±0.35) mmol/L, (38.77±4.43) mg/24 h vs. (35.54±4.41) mg/24 h, (15.59±2.19)% vs. (13.21±1.16)%, (18.82±2.31) μmol/L vs. (14.46±2.20) μmol/L, and (189.71±32.69) ng/L vs. (154.59±27.68) ng/L]; the estimated glomerular filtration rate (eGFR) in the patients with cardiovascular and cerebrovascular events was lower than that in the patients with no cardiovascular and cerebrovascular events [(40.56±7.12) ml/min/1.73 m² vs. (46.37±6.23) ml/min/1.73 m²]; there were statistical differences (t=3.126, 3.388, 3.043, 3.509, 7.303, 9.333, 5.683, and 4.239; all P<0.05). The logistic multivariate regression analysis showed that dialysis age, Hcy, FGF-23, and eGFR were the factors affecting the occurrence of cardiovascular and cerebrovascular events in the patients (all P<0.05). The ROC analysis showed that the sensitivities of Hcy, FGF-23, and their combination in the prediction of cardiovascular and cerebrovascular events in the patients were 71.68%, 76.57%, and 78.04%; the specificities were 78.59%, 74.31%, and 89.36%; the areas under the curves were 0.768, 0.745, and 0.886. Conclusions　Serum Hcy and FGF-23 levels are related to cardiovascular and cerebrovascular events in patients with uremia and hypertension taking hemodialysis. The risk of cardiovascular and cerebrovascular events is higher when Hcy and FGF-23 are at high levels. The combination of the two has higher efficacy in predicting cardiovascular and cerebrovascular events in patients with uremia and hypertension taking hemodialysis.

Key words:

Hemodialysis, Uremia complicated with hypertension, Homocysteine, Fibroblast growth factor-23, Cardiovascular and cerebrovascular diseases

摘要：

目的　分析血清同型半胱氨酸（Hcy）、成纤维细胞生长因子-23（FGF-23）预测血液透析治疗尿毒症合并高血压患者并发心脑血管事件的价值。方法　回顾性分析，选取2019年2月至2022年12月在黄石市中医医院收治的98例行血液透析治疗的尿毒症合并高血压患者的临床资料，其中男58例、女40例，年龄53～76（64.18±5.39）岁；另收集患者血清Hcy、FGF-23等临床资料，随访1年。统计随访期间患者发生心脑血管事件情况，采用t检验、χ²检验及logistic回归分析影响血液透析治疗尿毒症合并高血压患者心脑血管事件发生的因素，并绘制受试者操作特征曲线（ROC）分析Hcy与FGF-23预测其发生心脑血管事件的价值。结果　98例行血液透析治疗的尿毒症合并高血压患者中，有37例（37.76%）出现心脑血管事件，其余61例（62.24%）未出现心脑血管事件。两组患者性别、年龄、体质量指数、吸烟史、饮酒史、心率、高血压病程、收缩压、舒张压、降压药物使用种类、空腹血糖、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、前白蛋白、转铁蛋白、尿素氮、肌酐、尿酸、血清丙氨酸转氨酶、γ-谷氨酰转移酶、血钙、血磷、总尿素清除指数、血甲状旁腺素、左室射血分数比较，差异均无统计学意义（均P>0.05）；心脑血管事件组透析龄、血白蛋白、低密度脂蛋白胆固醇、尿白蛋白排泄率、红细胞分布宽度、Hcy、FGF-23均高于非心脑血管事件组［（4.83±0.81）年比（4.39±0.58）年、（36.33±5.08）g/L比（32.66±5.39）g/L、（3.59±0.75）mmol/L比（3.25±0.35）mmol/L、（38.77±4.43）mg/24 h比（35.54±4.41）mg/24 h、（15.59±2.19）%比（13.21±1.16）%、（18.82±2.31）μmol/L比（14.46±2.20）μmol/L、（189.71±32.69）ng/L比（154.59±27.68）ng/L］，估算肾小球滤过率（eGFR）低于非心脑血管事件组［（40.56±7.12）ml/min/1.73 m²比（46.37±6.23）ml/min/1.73 m²］，差异均有统计学意义（t=3.126、3.388、3.043、3.509、7.303、9.333、5.683、4.239，均P<0.05）。logistic多因素回归分析显示，透析龄、Hcy、FGF-23、eGFR水平是影响血液透析治疗尿毒症合并高血压患者心脑血管事件发生的因素（均P<0.05）。ROC分析结果显示，Hcy、FGF-23及二者联合预测血液透析治疗尿毒症合并高血压患者发生心脑血管事件的灵敏度分别为71.68%、76.57%、78.04%，特异度分别为78.59%、74.31%、89.36%，曲线下面积（AUC）分别为0.768、0.745、0.886。结论　血清Hcy、FGF-23水平与血液透析治疗尿毒症合并高血压患者并发心脑血管事件有关，Hcy、FGF-23处于高水平时心脑血管事件发生风险更高，二者联合预测血液透析治疗尿毒症合并高血压患者并发心脑血管事件效能较高。

关键词:

血液透析, 尿毒症合并高血压, 同型半胱氨酸, 成纤维细胞生长因子-23, 心脑血管疾病