血清尿酸变化率对腹膜透析患者结局预测作用研究

Predictive Effect of Serum Uric Acid Variation Rate on the Outcome of Peritoneal Dialysis Patients

目的探讨血清尿酸变化率(serum uric acid variation rate,UAR)对腹膜透析(peritoneal dialysis,PD)患者主要不良事件(major adverse events,MAE)的影响。方法采用便利抽样法选取2015年4月至2020年3月在江苏省某医院肾内科腹透中心行PD置管术并长期规律随访的患者185例,随访至2020年12月。比较MAE(全因死亡、主要心血管不良事件及PD相关腹膜炎)发生组与无发生组的临床特征差异,通过Cox回归分析UAR与MAE的相关性,将UAR根据25%、75%分位数分为轻度(<7.88%)、中度(7.88%~20.29%)、重度(>20.29%)增长三组,应用Kaplan-Meier生存曲线及Cox回归分析探究不同UAR增长程度与患者MAE的相关性。结果UAR增加是PD患者发生MAE的危险因素。Kaplan-Meier生存曲线结果显示,与UAR轻度增长组相比,UAR中度和重度增长组患者MAE发生率显著增加(χ^(2)=23.31,P<0.01),经多变量Cox回归模型校正后仍提示UAR中度和重度增加组相比轻度增加组是PD患者发生MAE的独立危险因素。结论UAR严重程度具有潜在的MAE风险预测价值。医护人员应动态监测PD患者尿酸变化情况,给予针对性干预措施,帮助患者减少MAE的发生。

Objective To explore the effects of serum uric acid variation rate(UAR)on major adverse events(MAE)among peritoneal dialysis(PD)patients.Methods Convenience sampling method was used to select 185 patients who underwent PD catheterization in the Peritoneal Dialysis Center of the Department of Nephrology in a hospital in Jiangsu Province from April,2015 to March,2020 and received regular follow-up until December,2020.The differences in clinical characteristics were compared between the groups with and not with the occurrence of MAE(all-cause death,major adverse cardiovascular events and PD-related peritonitis).The Cox regression was used to analyze the correlation between UAR and MAE.The mild(<7.88%),moderate(7.88%-20.29%)and severe(>20.29%)growth groups were determined according to the 25%and 75%quartiles of UAR.The Kaplan-Meier survival curve and Cox regression analysis were applied to explore the correlations between different degrees of UAR growth and patients’MAE.Results The growth of UAR was a risk factor of the development of MAE among PD patients.The Kaplan-Meier survival curves showed that the incidence of MAE in the moderate and severe UAR growth groups was significantly higher than that of the mild UAR growth group(χ^(2)=23.31,P<0.01).After adjustment by multivariate Cox regression model,the moderate and severe UAR growth was an independent risk factor of the development of MAE among PD patients.Conclusions The level of UAR shows a potentially predictive effect on the risk of MAE.Medical staff should dynamically monitor the UAR of PD patients and provide targeted intervention measures,so as to decrease the incidence of patients’MAE.