血磷对于维持性腹膜透析患者全因死亡风险的预测研究  

Prediction of All-cause Mortality Risk in Peritoneal Dialysis Patients with Serum Phosphorus

作　　者：乔诚 赵黎[1] 张海静[1] 倪燕萍 许涛[1] 汪年松[1] QIAO Cheng;ZHAO Li;ZHANG Haying(Department of Nejthrology,Shanghai Sixth Hospital Affiliated to Shanghai jiaolong Unitersity,Shanghai,200233;Department of Nephrology.Shanghai Hunan Hospital,Shanghai,200125)

机构地区：[1]上海交通大学附属第六人民医院肾内科,上海200233 [2]上海市浦东新区浦南医院肾内科,上海200125

出　　处：《中国中西医结合肾病杂志》2019年第10期867-871,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然基金面上项目(No.81400735,81670657);国家自然青年基金资助项目(No.81300560);上海市浦江人才计划项目(No.17PJ1407700);上海交通大学转化医学创新基金资助项目(No.152H2011);上海市徐汇区重点项目(No.SHXH201648);上海市综合医院中西医结合专项项目(No.ZHYY-ZXYJHZX-201608)

摘　　要：目的:探讨血磷对维持性腹膜透析患者全因死亡风险的预测作用。方法:选取2014年01月~2018年12月在上海市交通大学附属第六人民医院集团维持性腹膜透析的患者266例。检测空腹血磷水平及一般生化指标,根据血磷水平将患者分为观察组138例(血磷≥1.6 mmol/l),对照组128例(血磷<1.6 mmol/l),随访至2018年12月,记录全因死亡事件发生。分析两组间一般情况、生化结果的差异及与临床病理生理特征的关系,受试者工作特征曲线(receiver operating characteristic,ROC)分析血磷水平在腹膜透析中预测全因死亡事件的诊断价值,应用多元logistics回归模型评估发病风险。结果:共有266例腹膜透析患者入选,随访期间共发生全因死亡事件133例。观察组中发生全因死亡事件概率高于对照组,观察组患者的年龄、Hb、血糖水平低于对照组,IPTH、总铁结合力、ALB水平高于对照组,结果差异具有统计学意义(P<0.05),ROC曲线分析显示,血磷水平在腹膜透析患者中评判全因死亡有统计学意义,曲线下面积(area under curve,AUC)为AUC为0.645(95%Cl:0.57~0.71,P<0.001),灵敏度为86.4%,特异性为35.6%,预测全因死亡的诊断界值为1.26 mmol/l。校正传统危险因素后,多因素logistics回归分析显示,高血磷是腹膜透析患者发生全因死亡的高危因素,风险OR为1.23(1.02~4.63,P<0.05)。结论:高磷血症是维持性腹膜透析患者发生全因死亡的独立危险因素。Objective:to investigate the predictive effect of serum phosphorus on all-cause mortality risk in peritoneal dialysis(PD) patients.Methods:266 patients with maintenance PD in the sixth people’s hospital group affiliated to Shanghai jiaotong university from January 2014 to December 2018 were selected.Fasting blood phosphorus level and general biochemical indexes were measured. According to blood phosphorus level, the patients were divided into 138 cases in the observation group(blood phosphorus 1.6 mmol/l) and 128 cases in the control group(blood phosphorus < 1.6 mmol/l).The differences in general conditions, biochemical results between the two groups and their relationship with clinical and pathophysiological characteristics were analyzed. The receiver operating characteristic curve(ROC) was used to analyze the diagnostic value of blood phosphorus level in predicting all-cause death events in PD, and the multiple logistics regression model was used to assess the risk of disease.Results:a total of 266 PD patients were enrolled.All-cause death event probability in the observation group is higher than the control group, the age of the observation group, Hb, blood glucose level is lower than the control group, IPTH, total iron binding force, propagated level higher than the control group, the difference statistically significant(P<0.05), the ROC curve analysis showed that blood phosphorus levels in patients with peritoneal dialysis evaluation was statistically significant for all-cause mortality, area under the curve(area under the curve, AUC) for the AUC was 0.645(95%ci:0.57~0.71, P<0.001), sensitivity of 86.4%, specificity of 35.6%, predicted all-cause death diagnostic threshold of 1.26 mmol/l.After adjusting for traditional risk factors, multi-factor logistics regression analysis showed that high blood phosphorus was a high risk factor for all-cause death in pd patients, with a risk OR of 1.23(1.02~4.63,P<0.05).Conclusion:hyperphosphatemia is an independent risk factor for all-cause death in PD patients.

关 键 词：腹膜透析 全因死亡 高磷血症 

分 类 号：R73[医药卫生—肿瘤]