维持性血液透析患者血清尿酸水平与心血管死亡风险的分析

目的探讨血液透析（HD）患者血清尿酸水平与心血管死亡风险的关系。方法选择2008年1月至2013年1月982例HD患者，根据血清尿酸值进行三分类分组，主要终点事件是心血管死亡，采用Cox回归分析血清尿酸与心血管死亡风险的关系。三组间累计的心血管死亡风险采用Kaplan－Meier曲线和cox回归分析。结果平均随访25-3个月，最长随访72．0个月。血清尿酸平均值为7．02mg／dl（3．75～19．78mg／d1）。以TertileⅡ（6．8—7．4mg／d1）为参考组，TertileⅢ（7．5—18．9mg／d1）组患者的心血管死亡风险明显升高，校正后的心血管死亡风险比为2．28（95％CI．1．24—4．20．P=0．008）。TertileⅠ（4．0—6．7mg／d1）组患者的心血管死亡风险与TertileⅡ组无明显差异。Kaplan—Meier生存曲线联合COX归分析显示，TertileⅢ（7．5—18．9mg／d1）组患者的生存率最低（P〈0．001）。结论高尿酸血症可增加维持性血液透析患者的心血管病死率，提高死亡风险。

Objective To explore elevated serum uric acid （ SUA ） and cardiovascular mortality risk in hemodialysis patients.Methods We recruited 982 patients who underwent hemodialysis from January 2008 to January 2013, categorized according to tertile of SUA concentration.Survival was calculated using Kaplan-Meier Method and differences between the distributions of survival were assessed by log-rank test.Cox regression models were used to evaluate the relationship between uric acid tertiles with cardiovascular mortality, initially without adjustment, and subsequently adjusting for several groups of covariates. Results A total of 982 patients had a median follow-up of 25.3 months and a maximum follow-up of 72.0 months.In multivariate models, the higher tertile of SUA was associated with increased risk of cardiovascular mortality （ HR, 2.28 [ 95% CI, 1.24-4.20] ） . However, the risk of cardiovascular mortality in the lower tertile （ Tertile Ⅰ ） were similar with that in the middle tertile （ Tertile Ⅱ ） , showing no statistical significance.In COX regression analysis, the cumulative cardiovascular mortality was significantly different between tertiles of SUA, with the lowest survival in patients in the higher tertile （ Tertile Ⅲ ） （ P〈0.001 ） . Conclusion Elevated serum uric acid （ SUA ） could increase the incidence of higher cardiovascular mortality rate in hemodialysis patients.