维持性血液透析患者C反应蛋白联合白蛋白与死亡相关

C-reactive protein combined with serum albumin correlated with the mortality in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者C反应蛋白(C reactive protein,CRP)联合白蛋白(albumin,ALB)与全因死亡的关系。方法收集2012年1月至2016年12月北京民航总医院在北京市血液净化质量控制和改进中心数据登记系统中规律血液透析患者的一般情况、生化指标以及预后,评估CRP、ALB与全因死亡之间的关系。结果入选患者314例,平均年龄(63.32±13.57)岁,透析龄65.00(43.75,100.00)个月,死亡患者88例(28.03%)。CRP阳性(≥3 mg/L)157例(50.00%),ALB阳性(<38g/L)126例(40.13%)。CRP联合ALB将患者分为双阴性组109例、单阳性组127例和双阳性组78例,全因死亡分别占13.76%、26.77%和50.00%(χ~2=29.766,P<0.001)。Kaplan-Meier分析显示双阴性、单阳性、双阳性累积生存率依次降低(χ~2=39.380,P<0.001)。多因素COX回归提示,年龄(HR=1.022,95%CI 1.001~1.045,P=0.044)、糖尿病(HR=1.665,95%CI 1.068~2.596,P=0.024)是全因死亡的危险因素,血肌酐(HR=0.998,95%CI 0.997~0.999,P=0.005)是保护因素。CRP联合ALB单阳性作为参考,双阳性是全因死亡的危险因素(HR=1.709,95%CI 1.027~2.843,P=0.039)。结论和单独CRP或ALB相比,CRP联合ALB与死亡更相关,双阳性是全因死亡的独立危险因素。

Objective To investigate C-reactive protein （CRP） combined with serum albumin （ALB） in the prediction of all-cause mortality in maintenance hemodialysis （MHD） patients. Methods A total of 314 MHD cases treated in the period from Jan. 2012 to Dec. 2016 in the Hemodialysis Center of Civil Aviation General Hospital were registered in Beijing Hemodialysis Quality Control and Improvement Center Network. Their general information, laboratory results and outcomes were recruited. Results In the 314 MHD cases, the average age was 63.32± 13.57 years, the dialysis vintage was 65.00 （43.75, 100.00） months, and 88 pa- tients （28.03%） died. CRP was positive （≥3 mg/L） in 157 cases （50.00%） and ALB was positive （〈38 g/L） in 126 cases （40.13%）. According to CRP and ALB values, patients were divided into negative CRP and nega- tive ALB group （n=109）, positive CRP or positive ALB group （n=127）, and positive CRP and positive ALB group （n=78）; Statistical difference in all-cause mortality was found between the 3 groups （13.76%, 26.77% and 50.00% respectively; 22=29.766, P〈0.001）. Kaplan-Meier method showed that all-cause mortality was higher in patients with positive CRP and positive ALB than in patients with positive CRP or positive ALB, and was higher in patients with positive CRP or positive ALB than in patients with negative CRP and negative ALB （22=39.380, P〈0.001）. Multivariate Cox regression showed that age （HR=1.022, 95% CI 1.001 ~ 1.045, p=0.044） and diabetes （HR=1.665, 95% CI 1.06842.596, P=0.024） were the independent risk factors for all- cause mortality, and serum creatinine was the independent protective factor （HR=0.998, 95% CI 0.997-0.999, P=0.005）. If positive CRP or positive ALB group was used as a reference, positive CRP combined with posi- tive ALB was the independent risk factor for all-cause mortality （HR=1.709, 95% CI 1.027~2.843, P=0.039）. Conclusion C-reactive protein combined with serum albumin is closely related to all-cause mortality, i.e., positive CRP combined with positive ALB is the independent risk factor for all-canse mortality in MHD pa- tients.