腹膜透析患者血清镁与营养指标及死亡率的关系  

Relationship between serum magnesium and nutritional index and mortality of peritoneal dialysis patients

作　　者：宋聪聪[1] 郭福燕[1] 冉蕾[1] 魏维 于艳秋[1] 王秀芬[1] 林琼真[1] 李英[1] Song Congcong;Guo Fuyan;Ran Lei;Wei Wei;Yu Yanqiu;Wang Xiufen;Lin Qiongzhen;Li Ying(The Third Hospital of Hebei Medical University, Shijiazhuang 050000, China)

机构地区：[1]河北医科大学第三医院肾内科,050000

出　　处：《国际移植与血液净化杂志》2019年第1期5-11,共7页International Journal of Transplantation and Hemopurification

摘　　要：目的评估腹膜透析患者血清镁与全因死亡率及心血管疾病死亡率之间的关系,寻找影响血清镁水平的相关因素。方法回顾性分析我院2010月1月1日至2017年6月30日开始行腹膜透析并随访到2017年12月31日的共204例腹膜透析患者。收集这些患者的人口学信息、临床及实验室指标,分析患者血清镁水平与各个指标的关系,探究影响血清镁水平的因素。评估血清镁水平与腹膜透析患者全因死亡率及心血管疾病死亡率之间的关系。本研究的主要终点事件是腹膜透析患者全因死亡及心血管疾病导致的死亡。高镁血症的定义为血镁水平大于1.02 mmol/Lc结果共204例腹膜透析患者纳入本研究,其中男性占53.4%,女性占46.6%,糖尿病肾病所占原发病的比例为27.4%。患者开始行腹膜透析的平均年龄为(49. 3土15. 3)岁,患者透析龄的中位数为32个月。其中,65例患者(31.8%)存在高镁血症,135例患者血镁正常,4例患者(2%)存在低镁血症。血清镁水平与腹膜透析患者的年龄(r=-0.158,P =0.024)呈负相关,与血清白蛋白(r=0.258,P<0.001)、血清磷(r=0.251 ,P<0.001)、血肌ff(r =0.223,P=0.001)水平呈正相关。通过Logistics回归分析得出,血清白蛋白(P = 0.018)是高镁血症的独立影响因素。血镁正常组与高镁血症组在全因死亡率(P = 0.251)及心血管疾病死亡率(P=0.693)方面无显著差异。在多变量Cox回归分析中,高磷血症(HR = 0.350,P = 0.021)、高甲状旁腺激素水平(HR = 2.882,P=0.001)、糖尿病病史(HR = 7. 651 ,P<0. 001)是腹膜透析患者全因死亡率的预测因子,糖尿病病史(HR= 16.595,P<0.001)是腹膜透析患者心血管疾病死亡率的重要预测因子。结论(1)血清白蛋白水平是腹膜透析患者血清镁水平的独立影响因素。(2)血清镁对腹膜透析患者全因死亡率及心血管疾病死亡率没有影响。(3)高磷血症、高甲状旁腺激素水平、糖尿病病史与腹膜透析患者全因死亡率�Objective The purpose of the study was to evaluate the association between serum magnesium and mortality and cardiovascular mortality in peritoneal dialysis patients and search for risk factors influencing serum magnesium. Methods This was a single center retrospective study, this study included peritoneal dialysis patients from January 1 st, 2010 to June 30th, 2017 and followed to December 31 th, 2017 in our hospital. Demographic, clinical and laboratory indicators of the patients were collected. Risk factors influencing serum magnesium and evaluated the association between serum magnesium and mortality and cardiovascular mortality in peritoneal dialysis patients were searched for. The primary end point was all cause mortality and cardiovascular mortality of peritoneal dialysis patients. Hypermagnesemia was defined as serum magnesium greater than 1. 02 mmol/L. Results 204 peritoneal dialysis patients were included in our study, 53. 4% of them were male ,46. 6% were female and 27. 4% of them were diagnosed with diabetic nephropathy. The average age of patients starting peritoneal dialysis was (49. 4±15. 3 ) years old and the median duration of peritoneal dialysis was 32 months. Among them, 65 patients (31.8%) had hypermagnesemia, 135 patients (66. 2%) had normal serum magnesium, only 4 patients (2%) had hypomagnesemia. Serum magnesium levels had a negative association with age ( r =-0. 158 , P = G. 024), and had a positive association with serum albumin (r = 0. 258 , P<0. 001 ), serum phosphorus ( r = 0. 251 , P<0. 001), serum creatinine ( r = 0. 223 , P = 0. 001). According to Logistics regression analysis, serum albumin level ( P = 0. 018) was the independent influencing factor affecting serum magnesium level in patients with peritoneal dialysis. There was no significant difference in all cause mortality ( P = 0. 251 ) and cardiovascular mortality (P = 0.693) between serum magnesium normal group and hypermagnesemia group. In the multivariate Cox regression analysis, hyperphosphatemia (HZ?= 0.350, P = 0.021), h

关 键 词：血清镁 高镁血症 腹膜透析 影响因素 死亡率 

分 类 号：R692.5[医药卫生—泌尿科学]