终末期肾病患者血清晚期糖基化终末产物水平是首次动静脉内瘘术后狭窄的危险因素

doi:10.12122/j.issn.1673-4254.2025.08.11

摘要/Abstract

摘要：

目的探讨终末期肾病（ESRD）患者血清晚期糖基化终末产物（AGEs）对自体动静脉内瘘（AVF）狭窄的影响。方法前瞻性纳入2022年2月~6月于桂林医学院附属医院肾内科住院首次行标准自体动静脉内瘘（AVF）的终末期肾病患者，收集患者术前一般资料、临床检测指标、造瘘前术肢血管超声的数据，采用酶联免疫吸附法（ELISA）检测术前血清AGEs水平。根据术后2个月内是否狭窄分为狭窄组与非狭窄组，比较各组间AGEs及临床指标的差异性，采用Logistic 回归分析法分析动静脉内瘘狭窄的独立危险因素，采用受试者工作特征（ROC）曲线分析AGEs临床风险指标预测动静脉内瘘术后狭窄的灵敏度和特异度。结果共纳入94例患者，术后出现动静脉内瘘狭窄34例，未出现动静脉内瘘狭窄60例；狭窄组与非狭窄组间糖尿病患者数量差异具有统计学意义（P<0.001）。Spearman相关性分析提示AGEs水平与磷呈负相关（P<0.05）；狭窄组患者血清AGEs水平明显高于非狭窄组（Z=-2.837， P=0.005）；多因素Logistic回归分析提示AGEs为动静脉内瘘术后狭窄的独立危险因素（OR=1.251， 95% CI=1.096-1.423， P<0.001）；受试者工作特征（ROC）曲线分析提示：AGEs预测自体动静脉内瘘狭窄曲线下面积为0.677（P=0.007， 95% CI：0.572-0.770），最佳截断值为8.43 µg/mL，特异性为90.00%，灵敏度为52.94%；AGEs联合纤维蛋白原预测自体动静脉内瘘狭窄曲线下面积为0.763（P<0.001，95% CI： 0.664-0.844），最佳截断值为0.30，特异性为73.33%，灵敏度为70.59%。结论血清AGEs是自体动静脉内瘘术后狭窄的独立危险因素，血清AGEs联合纤维蛋白原构建的风险模型可提高预测自体动静脉内瘘术后狭窄的效能。

关键词: 晚期糖基化终末产物, 动静脉内瘘狭窄, 终末期肾病, 纤维蛋白原

Abstract:

Objective To investigate the effect of serum advanced glycation endproducts (AGEs) on stenosis after first autologous arteriovenous fistula (AVF) in patients with end-stage renal disease (ESRD). Methods Patients with ESRD undergoing standard native arteriovenous fistula (AVF) for the first time in the Department of Nephrology, Affiliated Hospital of Guilin Medical University from February to June 2022 were prospectively enrolled. The preoperative general data, clinical examination results and ultrasound data of the operated limbs were collected. The patients with and without stenosis within 2 months after the operation were compared for preoperative serum AGEs levels detected using ELISA and the clinical parameters. Logistic regression analysis was used to analyze the independent risk factors of AVF stenosis, and the sensitivity and specificity of AGEs for predicting postoperative stenosis were analyzed using receiver-operating characteristic (ROC) curve. Results Of the 94 patients enrolled, 34 had postoperative arteriovenous stenosis and 60 had no stenosis. The number of diabetic patients differed significantly between stenosis group and non-stenosis group (P<0.001). Serum AGEs levels, which were negatively correlated with serum phosphorus level (P<0.05), were significantly higher in stenosis group than in non-stenosis group (Z=-2.837, P=0.005). Serum AGE level was an independent risk factor for postoperative stenosis after AVF (OR=1.251, 95% CI:1.096-1.423, P<0.001). For predicting AVF stenosis, the area under the ROC curve (AUC) of AGEs was 0.677 (P=0.007, 95% CI: 0.572-0.770), with a specificity of 90.00% and a sensitivity of 52.94% at the optimal cut-off value of 8.43 µg/mL; AGEs combined with fibrinogen had an AUC of 0.763 (P<0.001, 95% CI: 0.664-0.844), with a specificity of 73.33% and a sensitivity of 70.59% at the optimal cut-off value of 0.30. Conclusions Elevated serum AGEs level is an independent risk factor for postoperative AVF stenosis, and its combination with fibrinogen has a better efficacy for predicting postoperative AVF stenosis.

Key words: advanced glycation end products, arteriovenous fistula stenosis, end-stage renal disease, fibrinogen

李天宏, 覃新芳, 韦丽丽, 毕慧欣. 终末期肾病患者血清晚期糖基化终末产物水平是首次动静脉内瘘术后狭窄的危险因素[J]. 南方医科大学学报, 2025, 45(8): 1663-1671.

Tianhong LI, Xinfang QIN, Lili WEI, Huixin BI. Elevated advanced glycation endproducts is a risk factor for stenosis after primary arteriovenous fistula surgery[J]. Journal of Southern Medical University, 2025, 45(8): 1663-1671.

图/表 8

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Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	x² /Z/t	P
Age (year, Mean±SD)	58±13	54±13	1.340	0.183
Gender (male/female) [n (%)]	19/15 (55.88)	36/24 (60.00)	0.152	0.697
Hyperlipemia [n (%)]	10 (29.41)	10 (16.67)	2.105	0.147
Hypertension [n (%)]	28 (82.35)	55 (91.67)	1.822	0.177
Smoking history [n (%)]	5 (14.71)	12 (20.00)	0.411	0.522
Diabetes [n (%)]	18 (52.94)	5 (8.33)	23.367	<0.001

Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	x² /Z/t	P
Age (year, Mean±SD)	58±13	54±13	1.340	0.183
Gender (male/female) [n (%)]	19/15 (55.88)	36/24 (60.00)	0.152	0.697
Hyperlipemia [n (%)]	10 (29.41)	10 (16.67)	2.105	0.147
Hypertension [n (%)]	28 (82.35)	55 (91.67)	1.822	0.177
Smoking history [n (%)]	5 (14.71)	12 (20.00)	0.411	0.522
Diabetes [n (%)]	18 (52.94)	5 (8.33)	23.367	<0.001

Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	t/Z	P
RBC (10¹²/L)	2.87 (2.55, 3.13)	2.85±0.67	-0.024	0.981
WBC (10⁹/L)	8.06 (5.89, 9.50)	7.15 (5.75, 9.07)	-1.137	0.256
Hb (g/L)	80.83±17.54	80.29±17.37	-0.144	0.886
PLT (10⁹/L)	259.24±93.72	190.50 (166.25, 239.75)	-2.526	<0.05
NEUT (10⁹/L)	5.19 (4.14, 7.36)	5.01 (3.91, 6.55)	-0.952	0.341
LY (10⁹/L)	1.27 (0.94, 1.72)	1.21 (0.81, 1.51)	-1.003	0.316
NLR	4.15 (2.91, 5.50)	3.81 (2.69, 6.31)	-0.362	0.717
PLR	212.40±91.31	172.60 (117.48, 231.73)	-1.180	0.238
Alb (g/L)	37.40 (33.78, 40.50)	37.65 (34.40, 39.68)	-0.354	0.723
TC (mmol/L))	4.31±1.07	3.94±1.05	1.642	0.104
TG (mmol/L)	1.11 (0.85, 1.87)	1.16 (0.80, 1.50)	-0.390	0.697
HDL-C (mmol/L)	0.94 (0.73, 1.23)	1.08±0.33	-1.047	0.295
LDL-C (mmol/L)	2.52±0.74	1.08±0.33	13.020	<0.01
ApoA (mmol/L)	1.08 (1.02, 1.24)	1.18±0.21	-1.316	0.188
ApoB (mmol/L)	0.80 (0.68, 0.96)	0.73±0.18	-1.909	0.053
Lp(a) (mmol/L)	30.00 (18.03, 79.08)	31.50 (16.43, 57.50)	-0.657	0.511
Scr (μmol/L)	818.65±304.00	872.08±271.07	-0.879	0.382
eGFR (mL/min/ 1.73m²)	6.03 (5.37, 8.58)	6.26 (5.03, 7.82)	-0.130	0.897
UA (μmol/L)	528.34±158.53	512.43±128.45	0.529	0.598
iPTH (pmol/L)	21.04 (16.23, 28.44)	24.33 (17.03, 31.20)	-1.007	0.314
Ca (mmol/L)	1.83±0.20	1.98±0.29	-1.927	0.057
P (mmol/L)	2.01 (1.64, 2.57)	2.07±0.53	-0.016	0.987
HCT (%)	0.25±0.54	0.25±0.55	-0.377	0.707
PT (s)	11.85 (11.20, 13.10)	12.00 (11.15, 12.50)	-0.555	0.579
APTT (s)	29.95 (27.50, 33.70)	28.50 (25.30, 31.30)	-2.038	<0.05
FIB (g/L)	4.30±1.29	3.56 (3.19, 4.41)	-1.897	0.058
D-dimer (μg/mL)	1.95 (0.57, 3.04)	0.87 (0.43, 2.80)	-1.436	0.151
BUN (mmol/L)	30.02±14.38	29.17±8.55	0.362	0.719

Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	t/Z	P
RBC (10¹²/L)	2.87 (2.55, 3.13)	2.85±0.67	-0.024	0.981
WBC (10⁹/L)	8.06 (5.89, 9.50)	7.15 (5.75, 9.07)	-1.137	0.256
Hb (g/L)	80.83±17.54	80.29±17.37	-0.144	0.886
PLT (10⁹/L)	259.24±93.72	190.50 (166.25, 239.75)	-2.526	<0.05
NEUT (10⁹/L)	5.19 (4.14, 7.36)	5.01 (3.91, 6.55)	-0.952	0.341
LY (10⁹/L)	1.27 (0.94, 1.72)	1.21 (0.81, 1.51)	-1.003	0.316
NLR	4.15 (2.91, 5.50)	3.81 (2.69, 6.31)	-0.362	0.717
PLR	212.40±91.31	172.60 (117.48, 231.73)	-1.180	0.238
Alb (g/L)	37.40 (33.78, 40.50)	37.65 (34.40, 39.68)	-0.354	0.723
TC (mmol/L))	4.31±1.07	3.94±1.05	1.642	0.104
TG (mmol/L)	1.11 (0.85, 1.87)	1.16 (0.80, 1.50)	-0.390	0.697
HDL-C (mmol/L)	0.94 (0.73, 1.23)	1.08±0.33	-1.047	0.295
LDL-C (mmol/L)	2.52±0.74	1.08±0.33	13.020	<0.01
ApoA (mmol/L)	1.08 (1.02, 1.24)	1.18±0.21	-1.316	0.188
ApoB (mmol/L)	0.80 (0.68, 0.96)	0.73±0.18	-1.909	0.053
Lp(a) (mmol/L)	30.00 (18.03, 79.08)	31.50 (16.43, 57.50)	-0.657	0.511
Scr (μmol/L)	818.65±304.00	872.08±271.07	-0.879	0.382
eGFR (mL/min/ 1.73m²)	6.03 (5.37, 8.58)	6.26 (5.03, 7.82)	-0.130	0.897
UA (μmol/L)	528.34±158.53	512.43±128.45	0.529	0.598
iPTH (pmol/L)	21.04 (16.23, 28.44)	24.33 (17.03, 31.20)	-1.007	0.314
Ca (mmol/L)	1.83±0.20	1.98±0.29	-1.927	0.057
P (mmol/L)	2.01 (1.64, 2.57)	2.07±0.53	-0.016	0.987
HCT (%)	0.25±0.54	0.25±0.55	-0.377	0.707
PT (s)	11.85 (11.20, 13.10)	12.00 (11.15, 12.50)	-0.555	0.579
APTT (s)	29.95 (27.50, 33.70)	28.50 (25.30, 31.30)	-2.038	<0.05
FIB (g/L)	4.30±1.29	3.56 (3.19, 4.41)	-1.897	0.058
D-dimer (μg/mL)	1.95 (0.57, 3.04)	0.87 (0.43, 2.80)	-1.436	0.151
BUN (mmol/L)	30.02±14.38	29.17±8.55	0.362	0.719

Variables	r	P
Age	0.148	0.155
RBC	0.005	0.962
WBC	-0.097	0.352
Hb	0.104	0.319
PLT	0.020	0.851
NEUT	-0.100	0.335
LY	0.080	0.445
NLR	-0.077	0.459
PLR	-0.069	0.509
Alb	-0.040	0.699
TC	0.086	0.409
TG	0.038	0.719
HDL-C	0.096	0.355
LDL-C	0.068	0.512
ApoA	-0.034	0.747
ApoB	0.084	0.421
Lp(a)	-0.031	0.770
Scr	-0.161	0.120
eGFR	0.031	0.768
BUN	-0.141	0.175
UA	-0.071	0.495
iPTH	-0.080	0.443
Ca	0.010	0.920
P	-0.203	＜0.05
HCT	0.057	0.587
PT	-0.151	0.146
APTT	-0.073	0.482
FIB	-0.054	0.608
D-dimer	0.192	0.063
Arterial diameter	-0.178	0.086
Venous diameter	0.115	0.269