维持性血液透析患者血清尿酸水平与死亡风险的关系分析

Relationship between elevated serum uric acid and mortality risk in hemodialysis patients

目的：探讨血液透析患者血清尿酸水平与死亡风险的关系。方法选择2008年1月至2013年1月广州军区广州总医院肾内科血液净化中心收治的血液透析患者，根据血清尿酸水平进行3分类分组，主要终点事件是死亡，采用COX回归分析血清尿酸与全因死亡风险的关系。3组间累计的全因死亡风险采用Kaplan-Meier曲线和COX回归分析。结果共982例血液透析患者纳入本研究，平均随访时间为25.3个月，最长随访时间为72.0个月。血清尿酸为223～1176（中位数418） mmol/L。以TertileⅡ（399～440 mmol/L）为参考组，TertileⅢ（441～1124 mmol/L）组患者的全因死亡风险明显升高，校正后的全因死亡风险比为1.46（95％ CI 1.23～1.77，P＜0.001）。Tertile I （238～398 mmol/L）组患者的全因死亡风险与 Tertile Ⅱ组比较差异无统计学意义（P＞0.05）。Kaplan-Meier生存曲线联合COX单变量分析显示，3组不同血清尿酸水平患者的全因死亡率比较差异无统计学意义（P＞0.05），但经校正混杂因素后的多因素分析表明，TertileⅢ组患者的生存率最低（P＝0.003）。结论高尿酸血症可增加维持性血液透析患者的病死率，提高死亡风险。

Objective To explore the association between elevated serum uric acid （SUA） and mortality risk in hemodialysis patients. Methods A total of 982 patients who underwent hemodialysis in General Hospital of Guangzhou Military Command of PLA from January 2008 to January 2013 were recruited in this study and categorized into three groups according to SUA concentration by Tertile analysis. Death was deemed as the end-point event. Cox regression models were used to evaluate the relationship between uric acid tertiles and all-cause mortality. Kaplan-Meier survival analysis and Cox regression models were adopted to assess the cumulative all-cause mortality among three groups. Results In total, 982 hemodialysis patients had a mean follow-up of 25.3 months and a maximum duration up to 72. 0 months. The mean concentration of serum SUA was 418 mmol/L （range： 223 ～ 1 176 mmol/L）. Regarding Tertile II of SUA as the reference standard （399 440 mmol/L）, the patients with Tertile III of SUA （441 - 1 124 mmol/L） had a significantly higher mortality with an all-cause mortality ratio of 1.46 after adjustment （95% C1 1.23 ～ 1.77, P 〈0. 001 ）. However, the risk of all-cause and CVD mortality between Tertile I （238 ～ 398 mmol/L） and II groups did not significantly differ （ P 〉 0. 05 ）. Kaplan-Meier survival analysis and Cox regression models revealed that no association was found between SUA levels and all-cause mortality in all groups. After adjustment of confounding factors, the survival rate in the Tertile III group was the lowest （ P = 0. 003 ）. Conclusion Elevated levels of SUA could increase the mortality risk of patients undergoing hemodialysis.