Predictive value of cathepsin level in peripheral blood on arteriovenous fistula stenosis and therapeutic effect of urokinase combined with argatroban in patients with maintenance hemodialysis / 中国医师进修杂志

ABSTRACT

Objective:To study the predictive value of peripheral blood cathepsin (Cat) level on arteriovenous fistula stenosis and therapeutic effect of urokinase combined with argatroban in patients with maintenance hemodialysis (MHD).Methods:The clinical data of 120 patients with MHD from January 2017 to January 2021 in the First Affiliated Hospital of Hebei North University were retrospectively analyzed. Among them, 72 patients had arteriovenous fistula stenosis (stenosis group), and 48 patients had not arteriovenous fistula stenosis (non-stenosis group). The patients in stenosis group were treated with urokinase combined with argatroban, and the therapeutic effect was evaluated; the stenosis degree of arteriovenous fistula stenosis was evaluated by digital subtraction angiography (DSA). The levels of Cat K and S in peripheral blood were detected by enzyme linked immunosorbent assay. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of Cat K and S in peripheral blood on arteriovenous fistula stenosis in patients with MHD. The independent risk factor of arteriovenous fistula stenosis in patients with MHD was analyzed by multivariate Logistic regression analysis.Results:The levels of Cat K and S in peripheral blood in stenosis group were significantly higher than those in non-stenosis group (404.34 ± 12.43) μg/L vs. (344.22 ± 12.09) μg/L and (124.55 ± 13.43) μg/L vs. (84.60 ± 12.45) μg/L, and there were statistical differences ( t = 26.39 and 16.68, P<0.01). The result of DSA showed that mild stenosis of arteriovenous fistula stenosis was in 33 cases, moderate stenosis in 23 cases, and severe stenosis in 16 cases. The levels of Cat K and S in peripheral blood in patients with moderate stenosis and severe stenosis were significantly higher than those in patients with mild stenosis (399.83 ± 11.79) and (476.27 ± 12.24) μg/L vs. (372.61 ± 12.88) μg/L, (125.77 ± 12.75) and (151.69 ± 11.86) μg/L vs. (110.54 ± 12.07) μg/L, the indexes in patients with severe stenosis were significantly higher than those in patients with moderate stenosis, and there were statistical differences ( P<0.01). After treatment, excellent was in 40 cases, effective in 23 cases, and ineffective in 9 cases. The levels of Cat K and S in peripheral blood in patients with effective and ineffective were significantly higher than those in patients with excellent (404.78 ± 10.96) and (491.30 ± 10.26) μg/L vs. (384.52 ± 10.36) μg/L, (121.85 ± 10.99) and (232.65 ± 10.61) μg/L vs. (101.78 ± 10.61) μg/L, the indexes in patients with ineffective were significantly higher than those in patients with effective, and there were statistical differences ( P<0.01). The ROC curve analysis result showed that the area under the curve of Cat K combined with Cat S in peripheral blood in forecasting arteriovenous fistula stenosis in patients with MHD was larger than that of Cat K and S alone (0.699 vs. 0.635 and 0.611), and the accuracy and specificity were also significantly higher (80.83% vs. 48.33% and 60.00%, 89.58% vs. 76.25% and 81.33%), the optimum cut-off values of Cat K and S in peripheral blood were 401.23 and 123.65 μg/L. Multivariate Logistic regression analysis result showed that the levels of Cat K and S in peripheral blood were the independent risk factor of arteriovenous fistula stenosis in patients with MHD ( OR = 1.02 and 1.63, 95% CI 0.90 to 1.93 and 1.33 to 2.32, P<0.01). Conclusions:The levels of Cat K and S in peripheral blood can predict the occurrence and extent of arteriovenous fistula stenosis in patients with MHD, and could also predict the therapeutic effect of urokinase combined with agatroban.