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黄　英，曹学森，滕　杰. 血清尿酸水平与维持性血液透析患者死亡风险的相关性[J]. 中国临床医学, 2024, 31(3): 420-427. DOI: 10.12025/j.issn.1008-6358.2024.20240202
引用本文: 黄　英，曹学森，滕　杰. 血清尿酸水平与维持性血液透析患者死亡风险的相关性[J]. 中国临床医学, 2024, 31(3): 420-427. DOI: 10.12025/j.issn.1008-6358.2024.20240202
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HUANG Y, CAO X S, TENG J. Relationship between serum uric acid and mortality in maintenance hemodialysis patients[J]. Chin J Clin Med, 2024, 31(3): 420-427. DOI: 10.12025/j.issn.1008-6358.2024.20240202
Citation: HUANG Y, CAO X S, TENG J. Relationship between serum uric acid and mortality in maintenance hemodialysis patients[J]. Chin J Clin Med, 2024, 31(3): 420-427. DOI: 10.12025/j.issn.1008-6358.2024.20240202
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血清尿酸水平与维持性血液透析患者死亡风险的相关性

Relationship between serum uric acid and mortality in maintenance hemodialysis patients

    摘要
  • 摘要:
    目的  探讨血清尿酸（serum uric acid, SUA）水平对维持性血液透析（maintenance hemodialysis, MHD）患者全因死亡率和心脑血管疾病死亡率的影响。
    方法  回顾性收集2015年1月1日至2016年12月31日在复旦大学附属中山医院行维持性血液透析患者的临床资料，根据SUA水平三分位值将患者分为低SUA组（SUA≤399 μmol/L）、中SUA组（SUA 400～460 μmol/L）、高SUA组（SUA≥461 μmol/L），比较3组患者临床资料和实验室检查结果。采用Kaplan-Meier法绘制生存曲线，log-rank检验比较3组患者生存率。采用多元Cox回归模型分析MHD患者SUA水平与全因死亡率、心脑血管疾病死亡率的关系。
    结果  共入选436例MHD患者，低SUA组149例、中SUA组144例、高SUA组143例。中位随访时间59.7(38.4, 60.9)个月，随访期间130例患者死亡，其中90例（69.2%）死于心脑血管疾病。Kaplan-Meier生存分析显示，低SUA组患者总生存率和心脑血管疾病生存率低于中SUA组和高SUA组。Cox回归分析显示，校正年龄、性别、合并症等因素后，SUA水平每升高10 μmol/L，患者全因死亡风险下降2.6%（HR＝0.974，95%CI 0.952～0.996，P＝0.022），心脑血管疾病死亡风险下降3.7%（HR＝0.963，95%CI 0.937～0.991，P＝0.008）；低SUA组患者的全因死亡（HR＝1.841，95%CI 1.138～2.979，P＝0.013)和心脑血管疾病死亡(HR＝2.353，95%CI 1.288～4.300，P＝0.005）风险高于高SUA组。
    结论  低SUA水平与MHD患者全因死亡和心脑血管疾病死亡独立相关。

     

    Abstract:
    Objective  To investigate the effect of serum uric acid (SUA) on all-cause mortality and cardio-cerebrovascular diseases mortality in maintenance hemodialysis (MHD) patients.
    Methods  Clinical data were retrospectively collected from MHD patients in Zhongshan Hospital, Fudan University from January 1, 2015, to December 31, 2016. The patients were categorized into low SUA group (SUA ≤399 μmol/L), medium SUA group (SUA 400-460 μmol/L), and high SUA group (SUA≥461 μmol/L) according to the tertiles of SUA level. The clinical data and laboratory examination results were compared among the three groups. The survival curves were plotted by Kaplan-Meier, and log-rank test were used to compare the survival rates among the three groups. Multivariate Cox regression was used to analyze the associations between SUA and all-cause mortality and cardio-cerebrovascular diseases mortality in MHD patients.
    Results  A total of 436 MHD patients were enrolled, including 149 in low SUA group, 144 in medium SUA group, and 143 in high SUA group. The median follow-up time was 59.7(38.4, 60.9) months. During the follow-up, 130 deaths were recorded, of which 90(69.2%) were due to cardio-cerebrovascular diseases. Kaplan-Meier survival analysis showed that the all-cause survival rate and cardio-cerebrovascular diseases survival rate of patients in low SUA group were lower than those in medium SUA group and high SUA group (P＜0.05). After adjusting for age, gender, comorbidities and other factors, the multivariate Cox regression analysis showed that the risk of all-cause mortality in patients decreased by 2.6% (HR＝0.974, 95%CI 0.952-0.996, P＝0.022) and the risk of cardio-cerebrovascular diseases mortality decreased by 3.7% (HR＝0.963, 95%CI 0.937-0.991, P＝0.008) for each 10 μmol/L increase in SUA level. The risks of all-cause mortality and cardio-cerebrovascular diseases mortality were significantly higher in low SUA group compared to high SUA group (HR＝1.841, 95%CI 1.138-2.979, P＝0.013; HR＝2.353, 95%CI 1.288-4.300, P=0.005).
    Conclusions  Low SUA level is independently associated with all-cause mortality and cardio-cerebrovascular diseases mortality in MHD patients.

     

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