同型半胱氨酸水平与维持性血透患者心血管及全因死亡的关系研究

Correlation of Homocysteine with Cardiovascular and All-Cause Mortality in Patients on Maintenance Hemodialy⁃sis

目的:探究维持性血液透析(MHD)患者高同型半胱氨酸血症(HHcy)的影响因素,明确同型半胱氨酸(Hcy)水平与MHD患者死亡风险的关系。方法:选取2021年6月1日-2023年5月31日在本院血液净化中心行规律血液透析治疗且符合纳入标准的终末期肾脏病(ESRD)患者284例,收集患者的一般资料及生化指标,根据患者是否死亡分为死亡组和生存组。再依据血清Hcy水平分为Hcy正常组和Hcy升高组。采用Kaplan-Meier和Log-rank检验比较Hcy正常组与Hcy升高组之间的生存率。应用Spearman相关性分析法分析影响Hcy水平的因素。采用Cox回归分析筛选MHD患者发生死亡的危险因素。应用ROC曲线分析Hcy对MHD患者全因死亡的预测价值。结果:Kaplan-Meier生存曲线结果表明,Hcy升高组的病死率明显高于Hcy正常组(Log-rank检验χ~2=6.288,P=0.012),Hcy升高组的中位生存时间显著低于Hcy正常组,提示Hcy水平可以预测MHD患者全因死亡。多因素Cox回归校正多项干扰因素后,血清Hcy水平仍与MHD患者死亡显著相关,血清Hcy水平升高是MHD患者死亡的独立危险因素。ROC曲线显示,Hcy预测MHD患者死亡的ROC曲线下面积为0.783,大于0.7,说明Hcy对MHD患者全因死亡具有一定的预测价值。结论:血清Hcy与MHD患者心血管事件死亡及全因死亡率相关,且是患者死亡的强预测因子。Hcy有望成为评估MHD患者死亡风险的新指标。

Objective To explore the influencing factors of hyperhomocysteinemia(HHcy)in the patients on maintenance hemodialysis(MHD),and to clarify the relationship between homocysteine(Hcy)levels and the risk of death in MHD pa⁃tients.Methods A total of 284 patients with end-stage renal disease(ESRD)and on MHD in the Dongfeng General Hospi⁃tal from June 1,2021 to May 31,2023 who met the inclusion criteria were enrolled in this study.The general information and the chemical indicator levels of the patients were collected.The patients were assigned into a death group and a survival group according to the death or survival conditions and a normal Hcy group and an elevated Hcy group according to the Hcy level.Kaplan-Meier and Log-rank tests were carried out to compare the survival rates between the two Hcy groups.Spearman correlation analysis was employed to analyse the factors affecting Hcy levels.Cox regression was performed to screen risk factors for the death in MHD patients.Finally,the receiver operating characteristic(ROC)curve was estab⁃lished to analyse the predictive value of Hcy for all-cause mortality in MHD patients.Results The Kaplan-Meier survival curves showed that the elevated Hcy group had higher mortality(Log-rank testχ2=6.288,P=0.012)and shorter median survival time than the normal Hcy group,suggesting that the level of Hcy can predict all-cause death in MHD patients.Af⁃ter correction of multiple confounders by multivariate Cox regression,the Hcy level was still significantly associated with the mortality of MHD patients,which indicated that elevated Hcy was an independent risk factor for death in MHD patients.The area under the ROC curve for the prediction of the death of MHD patients by Hcy was 0.783,which was greater than 0.7,suggesting that Hcy had a predictive value of the all-cause death of MHD patients.Conclusion Serum Hcy is associated with cardiovascular and all-cause mortality in MHD patients,serving as a strong predictor of patient death.Hcy is expected to be a new indicator for assessing the risk of death in MHD patients.