血清镁对老年男性急性肾损伤患者短期预后的影响

Impact of serum magnesium level on short-term prognosis in old male patients with acute kidney injury

目的对老年急性肾损伤(AKI)患者进行随访观察,探讨AKI患者血清镁紊乱发生情况及血清镁水平对老年AKI患者短期生存的影响。方法选择2007年1月至2015年12月就诊于解放军总医院老年病房≥75岁的住院男性AKI患者为研究对象。根据AKI后28 d时和60 d时患者的生存情况,将患者病历资料分为死亡组和存活组进行分析。以血清镁<0.7 mmol/L为低镁血症,>1.1 mmol/L为高镁血症。采用SPSS 17.0软件进行统计分析。Kaplan-Meier乘积法估计生存曲线,并通过对数秩检验进行比较,多因素Cox回归模型分析血清镁对老年患者短期生存的影响。结果 623例老年男性AKI患者,中位年龄87(84,91)岁。正常血镁者473例(75.9%),低镁血症患者72例(11.6%),高镁血症患者78例(12.5%)。发生AKI后28 d内死亡160例,60 d内共死亡194例。采用Kaplan-Meier生存曲线比较显示高镁血症患者28 d生存状况明显较差(log-rank检验:P=0.001)。多因素Cox回归分析显示AKI诊断时间(HR=0.865,95%CI 0.799~0.937;P<0.001)、平均动脉压(HR=0.970,95%CI 0.958~0.981;P<0.001)、血清前白蛋白(HR=0.924,95%CI 0.894~0.955;P<0.001)、少尿(HR=2.261,95%CI 1.424~3.590;P=0.001)、机械通气(HR=1.492,95%CI 1.047~2.124;P=0.027)、血尿素氮(HR=1.037,95%CI 1.025~1.049;P<0.001)、血镁水平(HR=2.512,95%CI 1.243~5.076;P=0.010)、AKI分期(2期:HR=3.709,95%CI 1.926~7.141,P<0.001;3期:HR=5.660,95%CI 2.990~10.717,P<0.001)是老年AKI患者28 d生存的影响因素。血清镁对患者29~60 d的生存影响无统计学意义。结论老年AKI患者镁离子紊乱发生率高达24.1%(150/623),高血镁与老年男性AKI患者28 d病死率密切相关,监测及适当纠正血镁紊乱可能会延长其生存时间。

Objective To investigate the magnesium disorder and determine the effect of serum magnesium level on short-term prognosis in the old patients with acute kidney injury( AKI). Methods The old male patients( ≥75 years old) with AKI admitted in the Geriatric Department of our hospital between January 2007 and December 2015 were enrolled in this study. According to their outcomes in 28 d and from 29 to 60 d after AKI respectively,they were also divided into survival and death groups. Hypomagnesemia is defined as serum magnesium < 0. 7 mmol/L,and hypermagnesemia as > 1. 1 mmol/L. SPSS statistics 17. 0 was used to perform the statistical analysis. The survival curves were estimated by Kaplan-Meier( product-limit) Estimator,and compared by Mantel( logrank) test. Multivariate Cox proportional regression model was used to analyze the effect of serum magnesium on short-term survival in elderly patients. Results There were 623 old male AKI patients included,at a median age of 87( 84,91) years,including 473 patients( 75. 9%) in the normal magnesium,72( 11. 6%) in hypomagnesemia,and 78( 12. 5%) in hypermagnesemia. One hundred and sixty patients( 24. 5%) died within 28 d after AKI,and 194 cases( 29. 8%) died within 60 d. The Kaplan-Meier survival curve showed the high magnesium patients had worse 28-day survival( log rank P = 0. 001). Multivariate Cox analysis revealed that time of AKI diagnosis( HR = 0. 865,95% CI 0. 799-0. 937; P < 0. 001),mean aortic pressure( HR = 0. 970,95% CI 0. 958-0. 981;P < 0. 001),serum prealbumin level( HR = 0. 924,95% CI 0. 894-0. 955; P < 0. 001), oliguria( HR = 2. 261,95% CI1. 424-3. 590; P = 0. 001),mechanical ventilation( HR = 1. 492,95% CI 1. 047-2. 124; P = 0. 027),blood urea nitrogen level( HR = 1. 037,95% CI 1. 025-1. 049; P < 0. 001),magnesium level( HR = 2. 512,95% CI 1. 243-5. 076; P = 0. 010) and AKI stages( stage 2: HR = 3. 709,95% CI 1. 926-7. 141,P < 0. 001; stage 3: HR = 5. 660,95% CI 2. 990-10. 717,P < 0. 001) were the influencing factors for 28-day mortality. However,no significant difference was found in serum magnesium level for 29 to 60-day mortality. Conclusion The incidence of magnesium disorder is up to 24. 1% in old male AKI patients. High serum magnesium level is associated with 28-day mortality,so more intensive monitoring and appropriate correction of serum magnesium level may prolong their survival time.