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的患者的临床资料,根据SUA水平的三分位间距将患者分为3组,比较3组患者临床资料和实验室检查结果的差异。采用Kaplan-Meier法绘制生存曲线,Log-rank检验比较3组患者生存率的差异。多元Cox回归方程法分析MHD患者SUA和全因死亡率、心脑血管疾病死亡率的关系。采用ROC曲线分析SUA对全因死亡和心脑血管疾病死亡的预测效果。 结果 共入选436例MHD患者,男性270例(61.9%),中位年龄60(48,67)岁,中位随访时间59.7(38.4,60.9)个月。根据SUA水平的三分位间距将患者分为3组:低SUA组(SUA≤399 μmol/L,n=149)、中SUA组(SUA 400~460 μmol/L,n=144)、高SUA组(SUA≥461 μmol/L,n=143)。在随访期间共130例死亡,其中90例(69.2%)死于心脑血管疾病。Kaplan-Meier生存分析结果显示,低UA组患者总生存率和心脑血管疾病生存率低于中UA组和高UA组。采用Cox回归分析校正年龄、性别、合并症等因素,结果显示SUA水平每增加10 μmol/L,患者的全因死亡风险下降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组患者的全因死亡和心脑血管疾病的死亡风险显著高于高SUA组(分别HR=1.841,95%CI 1.138~2.979,P=0.013;HR=2.353,95%CI 1.288~4.300,P=0.005)。结论 低SUA水平是MHD患者全因死亡和心脑血管疾病死亡的独立危险因素。 |
关键词: 血液透析 尿酸 全因死亡 心脑血管疾病死亡 |
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基金项目:厦门市科技计划项目(3502Z20194030),福建省2023年省级临床重点专科建设项目 |
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Relationship between serum uric acid and mortality in maintenance hemodialysis patients |
huang ying1, cao xue sen2, teng jie2
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1.Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University;2.Department of Nephrology, Zhongshan Hospital, Fudan University
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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 at Zhongshan Hospital of Fudan University from January 1, 2015, to December 31, 2016. The patients were categorized into three groups according to the tertiles of SUA level. The differences of the clinical data and laboratory examinations were compared among the three groups. The survival curves were plotted by Kaplan-Meier method, and Log-rank tests were used to compare the differences of survival rates among the three groups. Multivariate Cox regression was used to analyze the association between SUA and all-cause mortality and cardio-cerebrovascular diseases mortality in MHD patients. ROC curves were used to analyze the predictive effect of SUA on all-cause mortality and cardio-cerebrovascular diseases mortality. Results A total of 436 MHD patients were enrolled, 270 (61.9%) were male, with a median age of 60 (48, 67) years and a median follow-up of 59.7 (38.4, 60.9) months. The patients were categorized into low SUA group (SUA ≤399 μmol/L, n=149), medium SUA group (SUA 400-460 μmol/L, n=144), and high SUA group (SUA ≥461 μmol/L, n=143) according to the tertiles of SUA level. 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. After adjusting for age, gender, comorbidity and other factors, the results of multivariate Cox regression analysis suggested 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 risk of all-cause mortality and cardio-cerebrovascular diseases mortality was 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; respectively). Conclusions Low SUA level is an independent risk factor for all-cause mortality and cardio-cerebrovascular diseases mortality in MHD patients. |
Key words: hemodialysis uric acid all-cause mortality cardio-cerebrovascular diseases mortality |