他汀类药物对维持性血液透析患者生存预后的影响

Effect of statins on survival and prognosis in maintenance hemodialysis patients

目的探讨他汀类药物对维持性血液透析(MHD)患者生存预后的影响。方法回顾性研究。以2012年6月至2015年6月在徐州医科大学附属连云港医院血液透析中心接受MHD治疗的186例终末期肾病(ESRD)患者作为研究对象,男性114例、女性72例、年龄18~85岁,将入组前及随访期间连续3个月使用他汀类药物治疗的患者作为他汀组(48例),未使用他汀类药物治疗的患者作为非他汀组(138例)。收集患者一般资料,随访截止至2020年6月30日,记录患者临床结局。计量资料采用独立样本t检验,计数资料采用χ^(2)检验或Fisher确切概率法,生存率采用Kaplan-Meier生存分析,采用COX回归模型分析MHD患者生存预后的影响因素。结果与非他汀组比较,他汀组患者透析前收缩压(SBP)高、透析年份短、每周促红细胞生成剂使用剂量低、左心室射血分数(LVEF)大、白蛋白(Alb)水平高、总胆固醇(TC)和三酰甘油(TG)水平低、C反应蛋白(CRP)水平低(均P<0.05);与非他汀组比较,他汀组患者病死率低、因心血管疾病死亡比例低、3年和5年存活率高(均P<0.05)。年龄、体质量指数(BMI)、透析前SBP、透析年份、透析时间、心胸比率、LVEF、血红蛋白(Hb)、血清铁蛋白、Alb、甲状旁腺素(PTH)、尿素氮(BUN)、肌酐(Cr)、TC、TG、CRP及磷结合剂、碳酸钙、碳酸镧、司维拉姆、西那卡塞、维生素D、他汀类药物使用为MHD患者生存预后的影响因素(均P<0.05);校正其他因素对MHD患者生存预后的影响,显示他汀类药物使用可显著降低MHD患者死亡风险(HR:0.56,95%CI:0.51~0.59;P=0.017)。结论他汀类药物具有较好的抗炎作用,降低每周促红细胞生成剂使用剂量、心血管事件发生率,并可显著提高MHD患者3年和5年存活率,降低死亡风险,有临床应用价值。

Objective To investigate the effect of statins on the survival in maintenance hemodialysis(MHD)patients.Methods It was a retrospective study.A total of 186 patients with end-stage renal disease(ESRD)who received MHD treatment in the hemodialysis center of Xuzhou Medical University Affiliated Hospital of Lianyungang from June 2012 to June 2015 were selected as the research object,including 114 males and 72 females,aged 18-85 years.The patients treated with statins for 3 consecutive months before enrollment and during follow-up were taken as a statin group(48 cases),and the patients not treated with statins were taken as a non-statin group(138 cases).The patients'general data were collected,the patients were followed up until June 30,2020,and the clinical outcomes were recorded.Independent sample t test was used for the measurement data,χ^(2) test or Fisher's exact probability method was used for the count data,Kaplan-Meier survival analysis was used for the survival,and COX regression model was used to analyze the influencing factors of survival and prognosis in MHD patients.Results Compared with the non-statin group,the statin group had higher systolic blood pressure(SBP)before dialysis,shorter dialysis years,lower weekly dose of erythropoietin,higher left ventricular ejection fraction(LVEF),a higher albumin(Alb)level,lower total cholesterol(TC)and triglyceride(TG)levels,and a lower C-reactive protein(CRP)level(all P<0.05);compared with the non-statin group,the statin group had lower mortality,a lower death rate due to cardiovascular diseases,and higher 3-year and 5-year survival rates(all P<0.05).Age,body mass index(BMI),SBP before dialysis,dialysis years,dialysis duration,cardiothoracic ratio,LVEF,hemoglobin(Hb),serum ferritin,Alb,parathyroid hormone(PTH),urea nitrogen(BUN),creatinine(Cr),TC,TG,CRP,and usage of phosphorus bond,calcium carbonate,lanthanum carbonate,sevelamer,sensipar,vitamin D,and statins were the influential factors for survival and prognosis in MHD patients(all P<0.05).Adjusting for the influences of other factors on the survival and prognosis in MHD patients,statins significantly reduced the risk of death in MHD patients(HR:0.56,95%CI:0.51-0.59;P=0.017).Conclusion Statins have good anti-inflammatory,reduce the weekly dose of erythropoietin and the incidence of cardiovascular events,significantly improve the 3-year and 5-year survival rates in MHD patients,and reduce the risk of death,with clinical application values.