降钙素原水平与维持性血液透析患者全因死亡的关系

Relationship between procalcitonin level and all-cause death in maintenance hemodialysis patients

目的探讨降钙素原(PCT)水平与维持性血液透析(MHD)患者全因死亡的关系。方法选取MHD患者160例,收集其临床资料,包括性别、年龄、体质量指数(BMI)、吸烟史、原发疾病、合并症、透析时间、纽约心脏病学会(NYHA)心功能分级和实验室指标检测结果。采用受试者工作特征(ROC)曲线得出各项指标区分MHD患者死亡与存活的最佳临界值。以PCT>最佳临界值作为高PCT组,PCT≤最佳临界值作为低PCT组。采用二元Logistic回归分析评估高PCT水平的影响因素,采用Kaplan-Meier生存曲线分析MHD患者的生存率,采用Cox比例风险回归分析评估PCT与MHD全因死亡的关系。结果高PCT组透析时间和CRP水平高于低PCT组(P<0.01),其他项目2个组差异均无统计学意义(P>0.05)。二元Logistic回归分析结果显示,CRP水平升高是高PCT水平的危险因素[比值比(OR)值为1.182,95%可信区间(CI)为1.043~1.339,P=0.009]。Kaplan-Meier生存曲线分析结果显示,高PCT组生存率显著低于低PCT组(Log-rankχ^(2)=6.707,P=0.01;Breslow检验值为6.828,P=0.009)。Cox比例风险回归分析结果显示,高TG水平是MHD患者全因死亡的保护因素(HR=0.166,95%CI为0.071~0.387),高PCT水平是MHD患者全因死亡的危险因素[风险比(HR)=4.409,95%CI为1.757~11.064]。结论高PCT水平可能是MHD患者全因死亡的独立危险因素,或可作为终末期肾病(ESRD)的预后评估指标。

Objective To investigate the relationship between procalcitonin(PCT)level and all-cause death in patients undergoing maintenance hemodialysis(MHD).Methods A total of 160 patients undergoing MHD were enrolled,and their clinical data,including sex,age,body mass index(BMI),smoking history,primary disease,comorbidities,dialysis duration,New York Heart Association(NYHA)cardiac function classification and laboratory indicators,were collected.Receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value of death and survival in MHD patients.The patients with PCT>optimal cut-off value were taken as high PCT group,and those with PCT≤optimal cut-off value were taken as low PCT group.The influencing factors of high PCT were analyzed by binary Logistic regression.Kaplan-Meier survival curve was used to analyze the survival rate of MHD patients.Cox proportional risk regression analysis was used to evaluate the relationship between PCT and all-cause death in MHD patients.Results The dialysis duration and CRP levels in high PCT group were higher than those in low PCT group(P<0.01),but there was no statistical significance for the other indicators(P>0.05).Binary Logistic regression analysis showed that increased CRP level was a risk factor for high PCT[odds ratio(OR)=1.182,95%confidence interval(CI)1.043-1.339,P=0.009].Kaplan-Meier survival curve analysis showed that the survival rate of high PCT group was lower than that of low PCT group(Log-rankχ^(2)=6.707,P=0.01;Breslow test value was 6.828,P=0.009).Cox proportional risk regression analysis showed that high triglyceride(TG)level was a protective factor for all-cause death in MHD patients[hazard ratio(HR)=0.166,95%CI 0.071-0.387].High PCT level was a risk factor for all-cause death in MHD patients(HR=4.409,95%CI 1.757-11.064).Conclusions High PCT level may be an independent risk factor for all-cause death in MHD patients.