代谢综合征与腹膜透析患者心血管疾病及全因死亡的关系

Association of metabolic syndrome with cardiovascular disease mortality and all-cause mortality in peritoneal dialysis patients

目的:探讨腹膜透析(PD)患者代谢综合征(metabolic syndrome, MS)与心血管疾病(CVD)死亡和全因死亡的相关性。方法:回顾性分析2013年1月1日至2021年7月31日在绍兴市人民医院接受腹膜透析(PD)治疗患者的临床资料。根据MS诊断标准,将患者分为MS组和非MS组,比较2组患者临床资料、生化指标、合并症和临床结局的差异。应用逆概率处理加权法(IPTW)消除组间混杂因素的影响,Kaplan-Meier生存曲线分析患者生存率差异, Cox比例风险回归模型分析MS对全因死亡及CVD死亡的影响。 结果:共494例PD患者入选本研究,MS组266例,非MS组228例,平均随访(31±22)个月。2组患者基线资料比较中,吸烟史、饮酒史、CVD史、慢性肾小球肾炎患病率、左室射血分数、B型利尿钠肽、血红蛋白、血钙、超敏C反应蛋白、全段甲状旁腺素、超滤量、4 h腹透液肌酐与血肌酐比值的标准均数差( SMD)均大于0.1,IPTW后 SMD均下降至小于0.1,说明加权后组间均衡性良好。Kaplan-Meier生存曲线分析显示,MS组患者累积生存率及累积CVD生存率在IPTW前后均显著低于非MS组( P<0.05)。使用IPTW消除协变量对效应估计的影响后,多因素 Cox回归模型分析仍显示MS是患者全因死亡( HR=1.824,95% CI 1.121~2.968, P=0.015)和CVD死亡( HR=2.470,95% CI 1.324~4.609, P=0.004)的独立危险因素。 结论:腹膜透析患者的MS患病率较高,MS是腹膜透析患者全因死亡和CVD死亡的独立危险因素。

Objective To investigate the association of metabolic syndrome(MS)with cardiovascular disease(CVD)mortality and all-cause mortality in peritoneal dialysis patients.Methods A retrospective analysis was performed on patients who underwent peritoneal dialysis from January 1,2013 to July 31,2021 in the Shaoxing People′s Hospital.Patients were divided into MS group and non-MS group.The differences in baseline biochemical variables,comorbidities,and clinical outcomes between the two groups were compared.Kaplan-Meier method was used to obtain survival curves,the Cox regression model was used to evaluate the influence of MS for survival rates,and the inverse probability of treatment weighting(IPTW)was used to eliminate influence of the confounders in the groups.Results A total of 494 peritoneal dialysis patients were enrolled in this study,which were divided into MS group(n=266)and non-MS group(n=228).The total median follow-up time was(31±22)months.At baseline,the standard mean difference(SMD)in smoking history,drinking history,CVD history,prevalence of chronic glomerulonephritis,left ventricular ejection fraction,B-type natriuretic peptides,hemoglobin,blood calcium,hypersensitive C-reactive-protein,intact parathyroid hormone,ultrafiltration and 4 h dialysate/plasma creatinine in the two groups were greater than 0.1.Their SMD decreased to under 0.1 after IPTW,showing a good balance between the two groups.The analysis of the survival curve of Kaplan Meier showed that the cumulative survival rate and cumulative CVD survival rate in MS group were significantly lower than those in non-MS group before and after IPTW(P<0.05).After IPTW was used to eliminate the effect of confounders,multivariate Cox regression analysis still displayed that MS was an independent risk factor for all-cause mortality(HR=1.824,95%CI 1.121-2.968,P=0.015)and CVD mortality(HR=2.470,95%CI 1.324-4.609,P=0.004)in peritoneal dialysis patients.Conclusion The prevalence of metabolic syndrome is high in peritoneal dialysis patients.MS is an independent risk factor for all-cause mortality and CVD mortality in peritoneal dialysis patients.