维持性血液透析患者血磷变异程度与死亡相关  

Serum phosphorus variation is associated with mortality in maintenance hemodialysis patients

作　　者：蔡宏[1,2] 张伟明[1,2] 朱铭力[1] 陆任华[1] 林星辉[1] 鲁嘉越[2] 窦林斌 蒋蓉[2] 倪兆慧[1] 钱家麒[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,200001 [2]上海交通大学医学院附属仁济医院南院肾脏科

出　　处：《中华肾脏病杂志》2016年第7期487-493,共7页Chinese Journal of Nephrology

基　　金：上海交通大学医学院附属仁济医院南院临床学科创新共建平台建设项目（2014MDT02）;上海交通大学医学院附属仁济医院南院科研启动基金培育项目（2014qdq01）

摘　　要：目的：探讨维持性血液透析（maintenance hemodialysis，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2007年1月至2015年4月上海市透析登记系统中登记的502例上海交通大学医学院附属仁济医院血透中心MHD患者的一般资料、实验室指标检测结果及患者转归资料。根据血磷变异系数（CV）中位数，将患者分为血磷高变异组（CV≥0.226 mmol/L）和血磷低变异组（CV＜0.226 mmol/L），分析患者血磷CV与全因死亡、心血管疾病死亡之间的关系。结果入选患者平均年龄（63.9＆#177;14.6）岁，中位透析龄82.0（43.0，139.0）个月，死亡118例（23.5%），其中心血管疾病死亡64例（12.7%）。血磷高变异组MHD患者全因病死率高于低变异组（27.7%比19.3%，P=0.028）；其心血管疾病病死率高于低变异组，但差异无统计学意义（15.4%比10.0%，P=0.082）。COX回归分析显示，大于60岁（HR=2.762，95%CI：1.707～4.468，P＜0.001）、低血红蛋白（HR=0.466，95%CI：0.317～0.686，P＜0.001）、低血白蛋白（HR=0.555，95%CI：0.366～0.840，P=0.005）、血磷高CV（HR=1.479，95%CI：1.023～2.139，P=0.037）是MHD患者全因死亡的独立危险因素；大于60岁（HR=2.666，95%CI：1.469～4.837，P=0.001）、低血红蛋白（HR=0.480，95%CI：0.238～0.801，P=0.005）、血磷高CV （HR=1.655，95%CI：1.003～2.729，P=0.049）是MHD患者心血管疾病死亡的独立危险因素。血磷达标组全因死亡、心血管疾病死亡患者与未达标组患者的累积生存率差异无统计学意义（P值分别为0.065和0.425）。血磷高变异但达标患者全因病死率、心血管疾病病死率均高于低变异而达标患者（29.2%比15.3%，P=0.047；15.0%比6.0%，P=0.033）。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MHD患者累积生存率均低于血磷低变异组（P值分别为0.023和0.047）。结论 MHD患者血Objective To investigate the relationship between serum phosphorus variability and mortality in maintenance hemodialysis （MHD） patients. Methods A total of 502 MHD cases from Renji hospital hemodialysis center were registered in Shanghai Registry Network from January 2007 to April 2015. They were recruited with general information, laboratory results and outcomes. According to their median of coefficient of variation （CV） of blood phosphorus, the patients were divided into high variation group （CV≥0.226 mmol/L） and low variation group （CV〈0.226 mmol/L）. The relationship of serum phosphorus CV with all？cause mortality and cardiovascular disease mortality was assessed respectively. Results The average age was （63.9＆#177;14.6） years, the median dialysis age was 82.0 （43.0, 139.0） months, 118 patients （23.5%） died for all cause and 64 patients （12.7%） died for cardiovascular disease. Compared with patients in low phosphorus variation group, patients had a higher all？cause mortality in high phosphorus variation group （27.7% vs 19.3%, P=0.028）. Higher cardiovascular disease mortality was observed in high variation group as well, but this difference was no statistical significant （15.4% vs 10.0%, P=0.082）. COX regression analysis showed that 〉60 years of age （HR=2.762, 95%CI 1.707？4.468, P〈0.001）, low hemoglobin （HR=0.466, 95%CI 0.317？0.686, P〈0.001）, low albumin （HR=0.555, 95%CI 0.366？0.840, P=0.005）, high CV of phosphorus （HR=1.479, 95%CI 1.023 ？ 2.139, P=0.037） were independent risk factors for all ？ cause mortality. Moreover, 〉60 years of age （HR=2.666, 95%CI 1.469？4.837, P=0.001）, low hemoglobin （HR=0.480, 95%CI 0.238？0.801, P=0.005）, and high CV of phosphorus （HR=1.655, 95%CI 1.003？2.729, P=0.049） were independent risk factors for cardiovascular disease mortality. There was no significant statistical difference between patients phosphorus on target and patients phosphorus below target in all？cause disease mortal

关 键 词：肾透析 磷 死亡率 

分 类 号：R692.5[医药卫生—泌尿科学]