摘要目的:探讨血清血管生成素样蛋白6(ANGPTL6)与维持性血液透析(MHD)患者远期预后的相关性。方法:前瞻性纳入2015年3月至2020年5月沧州市中心医院门诊收治的216例维持性血液透析患者作为研究对象，另选取135例同时段于本院行健康检查的健康人作为对照组，通过酶联免疫吸附法(ELISA)检测血清ANGPTL6水平，全自动分析仪检测常规生化指标，并收集患者的性别、年龄、心血管疾病病史等临床特征参数。通过Pearson相关分析ANGPTL6水平与生化指标的相关性。对所有患者均随访3年，根据临床结局的不同，将MHD患者分为存活组和死亡组，通过单因素分析筛选影响患者疾病远期预后的风险因素，应用logistic回归分析风险因素与该疾病远期预后的相关性。结果:①MHD组患者的年龄、体重指数(BMI)、收缩压、舒张压及低密度脂蛋白(LDL-C)、总胆固醇(TC)、三酰甘油(TG)、超敏C反应蛋白(hs-CRP)、糖化血红蛋白和ANGPTL6水平均高于健康对照组，且颈动脉内膜中层厚度(CIMT)大于对照组，估算肾小球滤过率(eGFR)、高密度脂蛋白(HDL-C)水平低于对照组，差异均有统计学意义(均 P<0.001)；②ANGPTL6水平与各临床指标的Pearson相关性分析结果：ANGPTL6水平与TC、TG、LDL-C、收缩压、hs-CRP及CIMT值呈正相关(均 P<0.05)，与eGFR呈负相关( P<0.05)；③存活组与死亡组临床指标对比：在为期3年的随访过程中，死亡87例，病死率为40.28%(87/216)。死亡组患者的年龄、透析病程、CIMT及ANGPTL6水平均显著高于存活组，差异均有统计学意义(均 P<0.001)；死亡组患者中存在颈动脉斑块及心血管疾病病史的患者占比为77.01%、66.67%，较存活组的32.56%、20.16%明显偏多，差异均有统计学意义(均 P<0.001)；此外，两组患者的性别、BMI、收缩压及舒张压等指标均与MHD患者死亡之间无相关性(均 P>0.05)；④logistic回归分析结果显示，CIMT厚度及ANGPTL6水平均是影响MHD患者生存的独立预测因素( OR＝1.737，95% CI：1.185~2.545； OR＝3.622，95% CI：2.570~5.104)。 结论:血清ANGPTL6水平和CIMT厚度均是MHD患者死亡的重要预测因素，两者之间呈正相关，可作为临床预测MHD患者远期预后的参考指标。

abstractsObjective:To investigate the correlation between angiopoietin-like protein 6(ANGPTL6) and long-term prognosis of maintenance hemodialysis (MHD) patients.Methods:A total of 216 maintenance hemodialysis patients admitted to the outpatient department of Cangzhou central hospital from March 2015 to May 2020 were prospectively enrolled as the research objects. Another 135 healthy people who underwent health examination in the hospital at the same period were selected as the control group. Serum ANGPTL6 levels were detected by enzyme-linked immunosorbent assay (ELISA), and routine biochemical parameters were detected by automatic analyzer. Clinical characteristics including gender, age and history of cardiovascular diseases were collected. The correlation between ANGPTL6 levels and biochemical indicators was analyzed by Pearson correlation. All the patients were followed up for 3 years. According to the different clinical outcomes, the MHD patients were divided into survival group and death group. The risk factors affecting the long-term prognosis of the disease were screened by univariate analysis, and the correlation between the risk factors and the long-term prognosis of the disease was analyzed by loglist regression.Results:①Comparison of clinical indicators between MHD group and healthy control group: The mean age, body mass index (BMI), systolic blood pressure, diastolic blood pressure and the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), glycosylated hemoglobin and ANGPTL6 in MHD group were significantly higher than those in MHD group. In the healthy control group, the carotid intima-media thickness (CIMT) was greater than that in the control group, and the level of glomerular filtration rate (eGFR), high-density lipoprotein cholesterol (HDL-C) were significantly lower than that in the control group, and the differences were statistically significant (all P<0.001). ②Pearson correlation analysis between ANGPTL6 level and clinical indicators: ANGPTL6 level was positively correlated with TC, TG, LDL-C, systolic blood pressure, hs-CRP and CIMT (all P<0.05), and negatively correlated with eGFR ( P<0.05). ③Comparison of clinical indicators between survival group and death group: during the 3-year follow-up, 87 patients died, with a mortality rate of 40.28% (87/216). The average age, duration of dialysis, CIMT and ANGPTL6 level in the death group were significantly higher than those in the survival group (all P<0.001). The proportion of patients with carotid plaque and history of cardiovascular disease in the death group was about 77.01% and 66.67%, which was significantly higher than that in the survival group (32.56% and 20.16%), and the difference was statistically significant (all P<0.001). In addition, there was no correlation between gender, BMI, systolic blood pressure and diastolic blood pressure and death of MHD patients in the two groups (all P>0.05). ④Logistic regression analysis showed that CIMT thickness and ANGPTL6 level were independent predictors of MHD patients′ survival ( OR=1.737, 95% CI: 1.185-2.545; OR=3.622, 95% CI: 2.570-5.104). Conclusions:Serum ANGPTL6 level and CIMT thickness are both important predictors of death in MHD patients, and there is a positive correlation between them, which can be used as a reference index to predict the long-term prognosis of MHD patients.