血液透析患者近期心脑血管事件及远期全因死亡的危险因素

Risk factors of recent cardiovascular and cerebrovascular events and long-term all-cause mortality in hemodialysis patients

目的探讨血液透析(hemodialysis,HD)患者近期心脑血管事件及远期全因死亡的危险因素。方法该研究为两组回顾性队列研究。收集首都医科大学附属北京安贞医院HD中心HD患者的临床资料,按照患者接受HD治疗时间分为新入HD组(A组)和维持性HD组(B组)。A组终点事件定义为透析龄≤12个月发生的心脑血管事件或全因死亡;B组终点事件定义为全因死亡。按照随访期间是否发生终点事件将A组和B组患者均分为事件组和非事件组,分别比较两组基线及随访临床资料的差异。采用Cox回归模型分析HD患者发生终点事件的危险因素。结果A组纳入104例HD患者,年龄(61.54±14.97)岁,男性70例(67.3%),随访时间为12.0(10.0,12.0)个月,发生终点事件29例(27.9%)。A组中,与非事件组比较,事件组患者合并外周动脉疾病比例较高(χ^(2)=6.067,P=0.014),低密度脂蛋白胆固醇(t=-2.316,P=0.023)和体重指数(t=-2.245,P=0.028)均较低。B组纳入116例HD患者,年龄(65.89±10.06)岁,男性86例(74.1%),随访时间为37.5(21.0,59.0)个月,发生终点事件40例(34.5%)。B组中,与非事件组比较,事件组血白蛋白(t=-3.182,P=0.002)和血钾(t=-2.532,P=0.013)均较低。多因素Cox回归分析结果显示,高血红蛋白达标率(HR=0.977,95%CI 0.957~0.998,P=0.031)和高血白蛋白(HR=0.836,95%CI 0.776~0.901,P<0.001)是B组患者远期全因死亡的保护因素。结论合并外周动脉疾病、低低密度脂蛋白胆固醇和低体重指数可能增加新入HD患者近期心脑血管疾病发生的风险;而血红蛋白和血白蛋白不达标可能增加维持性HD患者远期全因死亡的风险。

Objective To explore the risk factors of recent cardiovascular and cerebrovascular events and long-term all-cause mortality in hemodialysis(HD)patients.Methods The clinical data of two groups of retrospective cohort study,which included newly admitted HD(group A)and maintenance HD(group B)patients respectively,were sourced from the HD Center of Beijing Anzhen Hospital,Capital Medical University.The endpoint events were defined as occurrence of cardiovascular or cerebrovascular events or all-cause mortality at less than 12 mouths of dialysis age in group A,and all-cause mortality in group B.The patients were divided into event group and non-event group based on whether endpoint events occurred during the follow-up period.The baseline and follow-up clinical data within the two groups were compared.Cox regression model was used to analyze the risk factors of endpoint events in HD patients.Results A total of 104 HD patients were enrolled in group A,with 70 males(67.3%),aged(61.54±14.97)years old.The follow-up time was 12.0(10.0,12.0)months,and 29 patients(27.9%)had endpoint events.In group A,the event group had a higher proportion of peripheral arterial disease(χ^(2)=6.067,P=0.014),and lower low-density lipoprotein-cholesterol(t=-2.316,P=0.023)and body mass index(t=-2.245,P=0.028)than those in the nonevent group.A total of 116 HD patients were enrolled in group B,with 86 males(74.1%),aged(65.89±10.06)years old.The follow-up time was 37.5(21.0,59.0)months,and 40 patients(34.5%)had endpoint events.In group B,the event group had lower serum albumin(t=-3.182,P=0.002)and potassium(t=-2.532,P=0.013)than those in the non-event group.Multivariate Cox regression analysis showed that high hemoglobin compliance rate(HR=0.977,95%CI 0.957-0.998,P=0.031)and high serum albumin(HR=0.836,95%CI 0.776-0.901,P<0.001)were protective factors of all-cause mortality in maintenance HD patients.Conclusions The presence of peripheral arterial disease,low low-density lipoprotein-cholesterol and low body mass index may increase the risk of recent cardiovascular and cerebrovascular events in newly HD patients.Substandard hemoglobin and serum albumin may increase the risk of long-term all-cause mortality in maintenance HD patients.