不同血磷变异系数的维持性血液透析患者死亡情况分析

Observation on death of MHD patients with different blood phosphorus variation coefficients

目的探讨不同血磷变异系数维持性血液透析(maintenance hemodialysis,MHD)患者的死亡情况。方法回顾性分析2014年1月至2016年12月我院血透中心透析龄≥3个月的MHD患者74例的临床资料。收集患者的一般资料和实验室生化检测指标,根据患者血磷变异系数(CV)的不同将其分为两组:血磷变异系数≥0.226 mmol/L为血磷高变异组(38例),血磷变异系数<0.226 mmol/L为血磷低变异组(36例)。分析不同血磷变异系数与MHD患者全因死亡和心血管疾病死亡情况的关系。结果在所有入选患者中,全因死亡患者占22.9%(17/24),心血管疾病死亡患者占12.2%(9/74),血磷高变异组全因病死率34.2%(13/38)显著高于血磷低变异组11.1%(4/36)(χ^2=5.574,P<0.05);且该组心血管疾病病死率15.8%(6/38)高于血磷低变异组8.3%(3/36),但两组相比差异无统计学意义(χ^2=0.962,P>0.05);血磷达标组与未达标组患者的全因死亡率和心血管疾病死亡率相比,差异均无统计学意义(χ^2=0.389、χ^2=0.065,P均>0.05);血磷达标组全因死亡和心血管疾病死亡的患者累积生存率与未达标组相比差异也均无统计学意义(P>0.05);血磷高变异组中血磷达标患者的全因死亡率和心血管疾病死亡率高于血磷低变异组中血磷达标患者,也高于血磷低变异组中血磷未达标患者,但两组相比差异均无统计学意义(χ^2=0.211,0.197,P>0.05)。生存曲线分析显示,血磷高变异组全因死亡和心血管疾病死亡患者的累积生存率均低于血磷低变异组,差异具有统计学意义(P<0.05)。结论血磷变异程度大的MHD患者全因病死率和心血管疾病病死率高,血磷变异程度有助于MHD患者死亡情况的预测。

Objective To investigate the death of MHD patients with different blood phosphorus variability.Methods The clinical data of seventy-four cases of MHD patients with more than 3 months dialysis age in the hemodialysis center of Chaozhou Central Hospital from January 2014 to December 2016 were retrospectively analyzed.The general data and laboratory biochemical indexes were collected and according to the difference in coefficient of variation(CV),the patients were divided into two groups:high blood phosphorus variability group(CV≥O.226 mmol/L)and low blood phosphorus variability group(CV<0.226 mmol/L).The relationship between the coefficient of variation and all-cause mortality and cardiovascular mortality in MHD patients was analyzed.Results Among all selected patients,all-cause mortality rate was 22.9%(17/24),12.2%(9/74)died of cardiovascular disease,and the all-cause mortality 34.2%(13/38)in the high blood phosphorus variability group was significantly higher than that in the other onel 1.1%(4/36)(χ^2=5.574,PvO.05);but there was no significant difference between the two groups in cardiovascular disease mortality(χ^2=0.962,P>0.05).And there was no significant difference between the serum phosphorus standard group and the substandard group in the all-cause mortality and the cardiovascular disease mortality(χ^2=0.389,0.065,P>0.05).There was no significant difference in the cumulative survival rate between the patients in the serum phosphorus standard group who experienced all-cause death and cardiovascular disease death and the patients in the substandard group(P>0.05).In the high blood phosphorus variability group,patients who reached serum phosphorus standard had higher total mortality rate and cardiovascular disease mortality rate,compared with patients who achieved serum phosphorus standard or experienced low phosphorus deficiency in the low blood phosphorus variability group(χ^2=0.211,0.197,P>0.05).Kaplan/Meier analysis showed that the cumulative suivival rates of all patients with all-cause death and cardiovascular death in the high blood phosphorus variability group were significantly lower than those in the low level group(P<0.05).Conclusion All-cause mortality and cardiovascular disease mortality are high in MHD patients with large variability in blood phosphorus,and the degree of blood phosphorus variation is helpful to predict the death of MHD patients.