【摘要】 目的 探讨血清几丁质酶-3样蛋白1(chitinase 3-like protein 1,CHI3L1)与血液透析患者全因死亡和心脑血管疾病死亡之间的关系。方法 本研究为前瞻性队列研究，病例来自2014年9月北京大学第三医院肾内科维持性血液透析患者。测定基线血CHI3L1水平，并根据中位数将患者分为高CHI3L1组和低CHI3L1组，随访9年。用Kaplan-Meier生存分析高CHI3L1组和低CHI3L1组患者生存率的差异，用限制性立方样条(restricted cubic spline,RCS)曲线描述CHI3L1与全因死亡率的剂量反应关系，用多因素COX比例风险模型分析患者全因死亡或心脑血管疾病死亡的独立危险因素。结果 共纳入109例患者，随访时间为80.0(38.2,113.2)个月。Kaplan-Meier生存分析显示高CHI3L1组患者全因死亡率高于低CHI3L1组(χ~2=4.720,P=0.030),2组患者心脑血管疾病死亡率无明显差异(χ~2=1.954,=0.162)。当CHI3L1≥199.8 ng/ml时，全因死亡率随着CHI3L1水平的增加有明显增加(HR=1.747,95%CI:1.035～2.947,P=0.037)。COX回归分析结果显示：年龄增加(HR=1.029,95%CI:1.001～1.056,=0.040)、长透析龄(HR=2.251,95%CI:1.310～3.868,P=0.003)、收缩压高(HR=1.022,95%CI:1.008～1.036,P=0.002)、血肌酐低(HR=0.135,95%CI:0.064～0.283,P<0.001)均为血液透析患者全因死亡的独立危险因素，多种因素校正后高CHI3L1仍然是患者全因死亡的独立危险因素(HR=1.963,95%CI:1.010～3.813,P=0.047)。结论 高CHI3L1组患者全因死亡率高于低CHI3L1组患者，血CHI3L1可能是血液透析患者全因死亡的独立预测指标。更多还原

【Abstract】 Objective This study aimed to determine the relationship bewteen serum Chitinase 3-like Protein 1(CHI3L1) and the mortality of patients with end-stage renal disease(ESRD) on haemodialysis(HD)and to evaluate the prognostic value of serum CHI3L1. Methods It was a prospective cohort study of kidney failure patients on HD at Peking University Third Hospital in September 2014 and were followed up until December 2023. Baseline serum CHI3L1 levels were measured using enzyme-linked immunosorbent assay(ELISA), then patients were divided into two groups(high-CHI3L1 group and low-CHI3L1 group) based on median CHI3L1. Overall survival and cardiovascular mortality were analyzed by the Kaplan-Meier method. The restricted cubic spline(RCS) curve was used to model and depict the relationship between baseline CHI3L1 and the risk of all-cause mortality in HD patients. The influence of CHI3L1 on outcome was analyzed using Cox regression method. Results 109 prevalent patients were enrolled. The follow-up period was 80.0(38.2,113.2) months. Kaplan-Meier survival analysis showed that all-cause mortality of patients in high-CHI3L1group was significantly higher than that in low-CHI3L1 group(χ~2=4.720, P=0.030), and there was no significant difference in cardiovascular mortality between these two groups(χ~2=1.954, P=0.162). When CHI3L1≥199.8 ng/ml, all-cause mortality significantly increased with the increase of CHI3L1 level(HR=1.747; 95%CI: 1.035～2.947, P =0.037). COX regression analysis showed that older age(HR=1.029, 95% CI:1.001～1.056, P =0.040), longer dialysis vintage(HR=2.251, 95% CI:1.310～3.868, P=0.003), higher systolic blood pressure(HR=1.022, 95% CI:1.008～1.036, P=0.002) and lower serum creatinine level(HR=0.13, 595% CI:0.064～0.28, P<0.001) were independent risk factors for all-cause mortality. After adjusting these factors,high CHI3L1 remained to be an independent predict factor for all-cause mortality in HD patients(HR=1.963,95% CI: 1.010-3.813, P=0.047). Conclusions The study suggested that all-cause mortality of HD patients in high-CHI3L1 group was significantly higher than that of patients in low-CHI3L1 group. Serum CHI3L1 was independently associated with all-cause mortality in HD patients.更多还原