摘要
目的探讨老年维持性血液透析(MHD)患者血磷变异程度与全因死亡、心血管疾病死亡的关系。方法收集2010年10月至2016年6月江阴市人民医院121例年龄大于60岁的MHD患者临床资料。根据血磷变异系数(CV)中位数,将患者分为血磷高变异组(CV≥0.18)和血磷低变异组(CV<0.18),分析患者血磷CV与全因死亡、心血管疾病死亡之间的关系。结果入选患者死亡40例(33.1%),其中心血管疾病死亡17例(14.0%)。血磷高变异组全因病死率高于低变异组(P=0.002);其心血管疾病病死率高于低变异组(P=0.003)。COX回归分析显示血磷高CV(HR=2.442,95%CI:1.253~4.760,P=0.009)、低血肌酐(HR=0.998,95%CI:0.996~1.000,P=0.017)、高C反应蛋白(HR=1.027,95%CI:1.008~1.046,P=0.006)是老年MHD患者全因死亡的独立危险因素;血磷高CV(HR=5.244,95%CI:1.486~8.507,P=0.010)和低血白蛋白(HR=0.829,95%CI:0.711~0.967,P=0.017)是老年MHD患者心血管疾病死亡的独立危险因素。Kaplan-Meier生存分析显示血磷高变异组全因死亡、心血管疾病死亡的老年MHD患者累积生存率低于血磷低变异组(P=0.001)。结论老年MHD患者血磷变异较大患者全因死亡和心血管疾病死亡风险高。
Objective To investigate the relationship between serum phosphorus variability and prognosis in elderly patients with maintenance hemodialysis (MHD). Methods A total of 121 patients over 60 years treated with MHD from hemodialysis center of Jiangyin people’s hospital were enrolled from October 2010 to June 2016 in this study. According to their median of coefficient of variation (CV) of blood phosphorus, the patients were divided into high variation group (CV≥0.18 mmol/L) and low variation group (CV<0.18 mmol/L). The relationship of serum phosphorus CV with all-cause mortality and cardiovascular disease mortality was assessed respectively. Results Forty patients (33.1%) died for all cause and 17 patients (14.0%) died for cardiovascular disease. Compared with patients in low phosphorus variation group, patients had a higher all-cause in high phosphorus variation group (40.6% vs.20.6%, P=0.002), higher cardiovascular disease mortality was observed in high variation group as well (24.1% vs.4.8%, P=0.003). COX regression analysis showed that high CV of phosphorus (HR=2.442, 95%CI: 1.253-4.760, P=0.009) , low serum creatinine (HR=0.998, 95%CI: 0.996-1.000, P=0.017) and high C-reactive protein were independent risk factors for all-cause mortality. Moreover, high CV of phosphorus (HR=5.244, 95%CI: 1.486-8.507, P=0.010) and low albumin (HR=0.829, 95%CI: 0.711-0.967, P=0.017) were independent risk factors for cardiovascular disease mortality. Kaplan-Meier method showed that patients with high phosphorus variation had higher all-cause and cardiovascular disease mortality than patients with low phosphorus variation(P=0.001). Conclusions The high CV of phosphorus is independently correlated with all-cause and cardiovascular disease mortality in elderly patients with MHD.
作者
张英姿
夏文楷
姚霞娟
刘金洪
胡宏
Zhang Yingzi;Xia Wenkai;Yao Xiajuan;Liu Jinhong;Hu Hong(Department of Nephrology ,Jiangyin Hospital Affiliated to Southeast University,Jiangyin 214400,China)
出处
《国际泌尿系统杂志》
2019年第1期100-104,共5页
International Journal of Urology and Nephrology
基金
江阴市科技局科研项目(澄政科[2017]92号).
关键词
肾透析
磷
老年人
预后
Renal Dialysis
Phosphorus
Aged
Prognosis
