血清尿酸水平对血液透析患者全因死亡及心血管死亡率的影响

Effect of serum uric acid concentration on all-cause mortality and cardiovascular mortality in hemodialysis patients

目的 分析血清尿酸水平对血液透析患者全因死亡及心血管死亡的影响。方法 选择2001年10月至2021年6月在安吉县人民医院进行血液透析的患者472例,依据血清尿酸水平将患者分为观察组191例(血清尿酸≥420μmol/L)和对照组281例(血清尿酸<420μmol/L)。另根据血清尿酸水平四分位数将患者分为4组:Q1组(血清尿酸<337.3μmol/L),Q2组(血清尿酸337.3~<398.2μmol/L),Q3组(血清尿酸398.2~<468.5μmol/L),Q4组(血清尿酸≥468.5μmol/L)。对所有患者每月随访。采用医院病历系统和(或)电话随访获取全因死亡及心血管死亡信息。采用Kaplan-Meier法绘制生存曲线。采用多因素Cox回归分析尿酸水平对各组全因死亡及心血管死亡的影响。结果 观察组全因死亡率及心血管死亡率高于对照组,差异均有统计学意义(均P<0.01)。血清尿酸水平与全因死亡率及心血管死亡率之间均呈“U形”关联。与Q2组比较,Q1组、Q4组全因死亡率及心血管死亡率更高,差异均有统计学意义(HR=8.909、12.021,10.673、18.909,均P<0.01)。结论血液透析患者血清尿酸水平控制在正常或略高(337.3~<468.5μmol/L)水平有利于降低全因死亡及心血管死亡率。

Objective To explore the effect of serum uric acid on all-cause mortality and cardiovascular mortality in patients on hemodialysis.Methods A total of 472 patients undergoing hemodialysis in Anji People's Hospital from October 2001 to June 2021 were enrolled.According to the level of serum uric acid,the patients were divided into an observation group(serum uric acid≥420μmol/L,n=191)and control group(serum uric acid<420μmol/L,n=281).In addition,the patients were divided into four groups according to the quartile of serum uric acid:group Q1(serum uric acid<337.3μmol/L),group Q2(serum uric acid 337.3-<398.2μmol/L),group Q3(serum uric acid 398.2-<468.5μmol/L),group Q4(serum uric acid≥468.5μmol/L).All patients were followed up monthly.The data of all-cause and cardiovascular death was obtained by case management system and/or telephone follow-up.Survival curves were plotted by Kaplan-meier method.Multivariate Cox regression analysis was used to analyze the impact of uric acid levels on all-cause mortality and cardiovascular mortality in each group.Results All-cause mortality and cardiovascular mortality were significantly higher in the observation group than in the control group(all P<0.01).There is a U-shaped association between serum uric acid level and all-cause mortality and cardiovascular mortality.Compared with group Q2,group Q1 and group Q4 had significantly higher all-cause mortality and cardiovascular mortality(HR=8.909,12.021,10.673,18.909,all P<0.01).Conclusion Control of serum uric acid level in hemodialysis patients at normal or slightly higher level(337.3-<468.5μmol/L)is beneficial to reduce all-cause mortality and cardiovascular mortality.