低血清总胆红素水平与腹膜透析患者全因死亡与心血管事件死亡的相关性  

Associations of low serum total bilirubin level with all- cause mortality and cardiovascular mortality in peritoneal dialysis patients

作　　者：范瑾瑾[1] 刘新辉[1] 易春燕[1] 林建雄[1] 阳晓[1] 余学清[1] Fan Jinjin;Liu Xinhui;Yi Chunyan;Lin Jianxiong;Yang Xiao;Yu Xueqing(Department of Nephrology,The First Affiliated Hospital of Sun Yat-sen University,Key Laboratory of National Health Commission,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院肾内科卫健委重点实验室,广州510080

出　　处：《中华肾脏病杂志》2018年第11期801-808,共8页Chinese Journal of Nephrology

基　　金：国家重点研发计划项目（2016YFC0906100）;国家自然科学基金（81774069、81570614）;卫计委公益性行业科研专项（201502023）;广东省医学科学技术研究基金项目（A2018042）

摘　　要：目的探讨腹膜透析患者低血清总胆红素（TBIL）水平与全因死亡及心血管事件死亡的相关性。方法单中心、回顾性、队列研究。纳入2006年1月1日至2010年12月31日在中山大学附属第一医院肾内科置管并腹膜透析3个月以上的新患者。收集并记录患者人口学资料、基线临床及实验室检查结果。所有患者随访至2012年12月31日。根据患者基线血清TBIL水平四分位数将所有患者分为4组。采用Kaplan—Meier法比较各组患者生存率。采用Cox回归模型分析TBIL与全因死亡及心血管事件死亡的相关性。采用Logistic回归分析低TBIL水平的影响因素。结果共880例具有基线TBIL数据的腹膜透析患者被纳入研究，年龄（48．0±15．4）岁，其中男性占59．0％；TBIL水平中位数（四分位数间距）为4．5（3．4，5．8）μmol／L。TBIL四分位数组间比较显示，4组间糖尿病患者比例、Charlson合并症指数、血红蛋白、血清白蛋白、血钙、全段甲状旁腺素、血尿素氮、谷丙转氨酶（ALT）、谷草转氨酶（AST）水平差异均有统计学意义（均P〈0．05），而年龄、体重指数（BMI）、估算的肾小球滤过率、血肌酐、血尿酸及血磷水平差异均无统计学意义。经过中位31个月的随访，194例患者死亡，其中104例为心血管事件死亡。Kaplan—Meier生存曲线显示基线血清TBIL≤3．4μmol／L（Q1组）患者全因死亡率较高（P=0．032），而心血管事件病死率组间比较差异无统计学意义。经人口学、合并症及肝功能等生化指标校正后，以Q2组（3．4〈TBIL≤4．5μmol／L）为参照，基线血清TBIL≤3．4μmol／L患者全因死亡的风险比为1．702（95％CI1．093—2．650，P=0．019），心血管事件死亡的风险比为1．760（95％CI0．960-3．227，P=0．068）。多因素Logistic回归分析结果显示，糖尿病（OR=1．065，95％CI1．010-1．122，P=0．019）及高BMI（OR=1．838，Objective To investigate the association of low serum total bilirubin （TBIL） level with all-cause mortality and cardiovascular mortality in peritoneal dialysis patients. Methods As a single- center, retrospective, cohort study, all the patients who underwent peritoneal dialysis catheterization in the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University and started peritoneal dialysis for more than 3 months from January 1, 2006 to December 31, 2010 were included. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until December 31, 2012. Patients were divided into 4 groups according to their baseline serum TBIL levels （interquartile range）. Kaplan- Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of TBIL with all- cause mortality and cardiovascular mortality. Logistic regression was used to analyze the influencing factors of low TBIL level. Results A total of 880 peritoneal dialysis patients with baseline TBIL data were enrolled in this study, with age of （48.0±15.4） years old, among whom 59.0% were male. Median TBIL was 4.5 μmol/L and interquartile range was 3.4-5.8 mol/L. The comparison between TBIL quartile groups showed that the difference in proportion of diabetics, Charlson comorbidity index, hemoglobin, serum albumin, serum calcium, intact parathyroid hormone, urea nitrogen, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） was statistically significant （all P 〈 0.05）, while the difference in body mass index （BMI）, estimated glomerular filtration rate, serum creatinine, urea nitrogen, uric acid and phosphorus was not statistically significant. After a median follow-up of 31 months, 194 patients died, 104 of which were cardiovascular deaths. Kaplan- Meier curves showed higher all-cause mortality in patients with TBIL≤3.4 μmol/L （Q1 group） （P=0.032） and there was no statistical difference in th

关 键 词：腹膜透析 胆红素 死亡率 心血管事件死亡 

分 类 号：R692.5[医药卫生—泌尿科学] R54[医药卫生—外科学]