维持性血液透析患者心脑血管预后的影响因素  

Risk factors for cardiovascular and cerebrovascular morbidity and mortality in maintenance hemodialysis patients

作　　者：马惠娟[1,2] 唐骅[1] 吕凛生[3] 王燕妮[1] 王彩霞[1] 刘迅[1] 娄探奇[1] 

机构地区：[1]中山大学附属第三医院肾内科,广州510630 [2]江门市中心医院肾内科 [3]中山大学附属第三医院手术麻醉中心,广州510630

出　　处：《中华肾脏病杂志》2015年第9期652-657,共6页Chinese Journal of Nephrology

基　　金：基金项目：国家自然科学基金（81070612和81370866）;国家科技支撑计划（2011A110800）;中国博士后科学基金（20090460774）;广东省科技计划（20138021800190）;广东省卫生厅基金（A2009196）;中山大学医科2012年第一批学生业余科研暨科研助理计划项目（医教[2012129号-78）

摘　　要：目的分析影响维持性血液透析患者心脑血管并发症预后的相关因素。方法研究对象为2009年1月1日至2014年12月31日在中山大学附属第三医院进行维持性血液透析超过3个月患者，记录患者人组时基线及每年度变化的透析相关指标、实验室指标及相关用药情况，随访至出现心脑血管事件或死亡，采用Cox比例风险回归和依时协变量Cox回归分析患者预后的影响因素。结果共人组243例维持性血液透析患者，年龄（53．2±16．4）岁，男性138例（56．8％）。经混杂因素调整后，入组基线年龄增长（HP=1．040，95％CI：1．015～1．065，P=0．002）、红细胞生成素剂量减少（HR=0．914，95％CI：0．846～0．987，P=0．022）以及透析治疗开始前合并心脑血管病史（HR=4．045，95％CI：2．074～7．890，P〈0．001）是患者心脑血管预后的独立影响因素。经过基线独立影响因素调整后，血磷升高（HR=1．722，95％CI：1．034～2．866，P＝0．037）是患者心脑血管预后的独立依时影响因素。结论年龄增长、红细胞生成素剂量减少和透析治疗开始前合并心脑血管病史是维持性血液透析患者心脑血管预后的独立危险因素。血磷升高是维持性血液透析患者心脑血管预后的依时协独立危险因素。Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease （CCVD） in maintenance hemodialysis （MHD） patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 34 Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1^st, 2009 to Dec 31^st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of （53.2±16.4） years old, and 138 of them were male （56.8%）. The multivariate Cox proportional model revealed that age （HR=1.040, 95% CI： 1.015- 1.065, P=0.002）, Erythropoietin （EPO） dose （HR=0.914, 95%CI： 0.846-0,987, P=0.022） and history of cardiovascular and cerebrovascular disease （HR=4.045, 95% CI： 2.074- 7.890, P 〈 0.001）were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time- dependent serum phosphorus level （HR=1.722, 95% CI： 1.034- 2.866, P=0.037） was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovaseular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.

关 键 词：肾透析 危险因素 心血管疾病 依时协变量Cox回归 

分 类 号：R692.5[医药卫生—泌尿科学]