关键词: 腹膜透析, 持续不卧床, 补体C1q/肿瘤坏死因子相关蛋白5, 利钠肽, 脑, 左室舒张功能, 诊断价值

Abstract:

Objective To investigate the correlation between serum complement C1q/tumor necrosis factor related protein 5 (CTRP5) and left ventricular diastolic dysfunction (LVDD) in patients with continuous ambulatory peritoneal dialysis (CAPD), and to evaluate the diagnostic value of serum CTRP5 for LVDD in CAPD patients. Methods A total of 114 CAPD patients who were regularly followed up and treated at the Affiliated Hospital of Chengde Medical College from December 2020 to August 2021 were selected, and their clinical data were collected. Patients were allocated to LVDD group (n=85) and normal left ventricular diastolic function (NLVDD) group (n=29) based on the presence or absence of LVDD. The multivariate Logistic regression analysis was performed to explore the independent risk factors of LVDD in CAPD patients, and diagnostic models were established based on each independent risk factors. The diagnostic value of various risk factors and diagnostic models for LVDD in CAPD patients was assessed using receiver operating characteristic (ROC) curves. Results Compared with those in NLVDD group, patients in LVDD group were older, and the proportion of diabetes, systolic blood pressure, serum CTRP5, and brain natriuretic peptide (BNP) levels were significantly higher, while albumin levels were significantly lower (P<0.05). Multivariate logistic analysis showed that age, serum CTRP5, and BNP were independent risk factors for LVDD in CAPD patients (P<0.05). The ROC curve showed that the area under the curve (AUC) of serum CTRP5 for diagnosing LVDD in CAPD patients was 0.902(95%CI: 0.828-0.975), with a cut-off value of 36.78 ng/ml (sensitivity=0.894, specificity=0.862). The AUC of LVDD in CAPD patients diagnosed with serum BNP was 0.886(95%CI: 0.821-0.950), with a cut-off value of 748.22 pg/ml (sensitivity=0.859, specificity=0.759). The AUC of LVDD in CAPD patients diagnosed with age was 0.773(95%CI: 0.678-0.868), with a cut-off value of 47.50 years old (sensitivity=0.753, specificity=0.690). A diagnostic model for predicting the risk of LVDD in CAPD patients was as follows: Y=-12.472+0.139×CTRP5+0.005×BNP+0.083×Age. The AUC of LVDD in CAPD patients diagnosed with this model was 0.933(95%CI: 0.875-0.991), with a cut-off value of 0.401(sensitivity=0.918, specificity=0.897).Conclusion Age, serum CTRP5, and BNP are independent risk factors for LVDD in CAPD patients. The diagnostic efficacy of the diagnostic model based on the independent risk factors of LVDD in patient with CAPD is better than a single indicator, providing clinical reference for timely detection of LVDD in CAPD patients.

Key words: peritoneal dialysis, continuous ambulatory, complemented-C1q/tumor necrosis factor-related protein 5, natriuretic peptide, brain, left ventricular diastolic function, diagnostic value