摘要
目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清尿酸(serum uric acid,SUA)与心血管疾病(cardiovascular death,CVD)死亡和全因死亡之间的关系。方法 回顾性分析2016年1月1日至2020年12月31日在川北医学院附属医院血液净化中心规律透析的MHD患者临床资料,参照2019年中国痛风诊断和治疗指南建议将患者按SUA水平分为四组,比较四组患者一般资料,分析SUA水平与临床指标的相关性,采用Kaplan-Meier方法和Cox风险回归模型来检验MHD患者中SUA水平与全因死亡率和CVD病死率之间的关系。结果 研究共纳入278例患者,年龄(58.61±15.17)岁,透析龄45.00(24.00,72.00)个月,随访时间39.50(22.00,60.00)个月。Kaplan-Meier生存曲线显示,SUA<360μmol/L组患者总生存率和CVD生存率低于其他3组(分别Log-Rankχ^(2)=24.859;P<0.001;Log-Rankχ^(2)=12.738;P=0.005)。在调整了多项混杂干扰因素后,Cox回归分析结果显示,A1(SUA<360μmol/L)组患者全因死亡发生风险高出A0(360μmol/L≤SUA<420μmol/L)组1.672倍(HR=5.322,95%CI 1.778~15.931,P=0.003),CVD死亡发生风险高出A0组1.488倍(HR=4.426,95%CI 1.217~16.098,P=0.024)。结论 在MHD患者中,SUA水平与全因死亡和CVD死亡相关,SUA<360μmol/L是MHD患者全因死亡和CVD死亡的独立危险因素。
Objective To explore the relationship between serum uric acid(SUA)and cardiovascular death(CVD)and all-cause death in maintenance hemodialysis(MHD)patients.Methods From January 1,2016 to December 31,2020,clinical data were retrospectively reviewed for 278 regular MHD patients at our Blood Purification Center.The SUA levels were divided into 4 groups according to the 2019 Chinese Guidelines for Diagnosing&Treating Gout.General data of four groups were compared and the correlation between SUA levels and clinical parameters was elucidated.Kaplan-Meier method and Cox hazard regression model were utilized for examining the relationship between SUA levels and all-cause death and CVD mortality in MHD patients.Results There was a mean age of(58.61±15.17)years,a median dialysis age of 45(24.00-72.00)months and a median follow-up period of 39.50(22.00-0.00)months.Kaplan-Meier survival curve indicated that overall and CVD survivals were lower in SUA<360μmol/L group than in the other three groups(Log-rankχ^(2)=24.859;P<0.001;Log-rankχ^(2)=12.738;P=0.005).After adjusting for multiple confounding factors,Cox regression analysis revealed that group A1(SUA<360μmol/L)had a 1.672-fold higher risk of all-cause death(HR=5.322,95%CI 1.778 to 15.931,P=0.003)and a 1.488-fold higher risk of CVD death(HR=4.426,95%CI 1.217 to 16.098,P=0.024)than those in group A0(360μmol/L≤SUA<420μmol/L).Conclusions In MHD patients,SUA level is correlated with allcause and CVD deaths.And SUA<360μmol/L is an independent risk factor for all-cause and CVD deaths in MHD patients.
作者
郭雪梅
朱朕男
许杨
敬雪明
张和平
Guo Xue-mei;Zhu zhen-nan;Xu Yang;Jing Xue-ming;Zhang He-ping(Department of Nephrology,Affiliated Hospital,North Sichuan Medical College,637000,China)
出处
《临床肾脏病杂志》
2023年第5期381-387,共7页
Journal Of Clinical Nephrology
基金
四川省卫生健康委重点研究项目(19ZD006)。