血液透析患者血清镁与身体组成成分及生存率的相关性

Correlation of serum magnesium level with body composition and survival in hemodialysis patients

目的探讨血液透析患者血清镁水平与身体组成成分(体细胞质量指数、过度水合、过度水合/细胞外水分比值、无脂组织指数和脂肪组织指数)及3年累积生存率的关系。方法选取210例持续性血液透析患者,收集所有患者临床初次检查(基线)的资料,同时检测血清镁、β2-微球蛋白(β2-MG)、血红蛋白(Hb)、白蛋白(Alb)、C反应蛋白(CRP)、血清钙、甲状旁腺激素、磷酸盐和身体组成成分。根据血清镁水平将所有患者分为3组(低水平血镁组、中水平血镁组、高水平血镁组)。采用Logistic回归分析评估血液透析患者低镁血症(血镁<0.73 mmol/L)的危险因素。采用Kaplan-Meier分析比较患者3年全因累积生存率。采用Cox回归分析确定血液透析患者3年全因死亡的危险因素。结果与中水平血镁组和高水平血镁组相比,低水平血镁组患者年龄较大(P<0.05),透析时间较短(P<0.05),血清CRP水平、过度水合/细胞外水分比值升高(P<0.05),血清Alb水平、体细胞质量指数降低(P<0.05),过度水合升高(P<0.05)。其他项目3个组之间差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,透析时间和水合过度/细胞外水分比值是血液透析患者低镁血症的危险因素[比值比(OR)值分别为1.04、1.02,95%可信区间(CI)分别为1.01~1.08、1.00~1.04]。当充分校正年龄、性别、体质量指数(BMI)、糖尿病史和血压后,血液透析患者死亡风险升高的危险因素为低镁血症和Alb[风险比(HR)值分别为1.71、1.79,95%CI分别为1.04~2.52、1.71~1.98]。结论低镁血症与透析时间和水合过度/细胞外水分比值显著相关,是血液透析患者3年全因死亡的独立危险因素。

Objective To investigate the relationship between serum magnesium level and body composition(somatic cell mass index,over-hydration,over-hydration/extracellular water ratio,non-adipose tissue index and adipose tissue index)and 3-year cumulative survival rate in hemodialysis patients.The baseline(initial examination)clinical data of patients were collected,and serum magnesium,beta2-microglobulin(β2-MG),hemoglobin(Hb),albumin(Alb),C-reactive protein(CRP),serum calcium,parathyroid hormone,phosphate and body composition were determined.All the patients were classified into 3 groups according to serum magnesium levels(low-level magnesium group,middle-level magnesium group and high-level magnesium group).Logistic regression analysis was used to evaluate the risk factors of hypomagnesemia(serum magnesium<0.73 mmol/L)in hemodialysis patients.Kaplan-Meier analysis was used to compare the 3-year cumulative all-cause survival.Cox regression analysis was used to determine the risk factors of 3-year all-cause mortality in hemodialysis patients.Results Compared with the middle-level magnesium group and the high-level magnesium group,the low-level magnesium group was elder(P<0.05),the dialysis time was shorter(P<0.05),the serum CRP level and over-hydration/extracellular water ratio were higher(P<0.05),serum Alb level and somatic cell mass index were lower(P<0.05),and the over-hydration was higher(P<0.05).There was no statistical significance in the other items among the 3 groups(P>0.05).Logistic regression analysis showed that dialysis time and over-hydration/extracellular water ratio were risk factors for hypomagnesemia in hemodialysis patients[odds ratios(OR)were 1.04 and 1.02,95%confidence intervals(CI)were 1.01-1.08 and 1.00-1.04,respectively].When adjusted for age,sex,body mass index(BMI),the history of diabetes mellitus and blood pressure,hypomagnesemia[hazard ratio(HR)=1.71,95%CI 1.04-2.52]and Alb(HR=1.79,95%CI 1.71-1.98)were risk factors for increased mortality in hemodialysis patients.Conclusions Hypomagnesemia is correlated with dialysis time and over-hydration/extracellular water ratio,which is an independent risk factor for 3-year cumulative survival of hemodialysis patients.