维持性腹膜透析患者血清总胆红素水平与全因死亡、心血管事件死亡的相关性  

Correlation between serum total bilirubin level and all cause death and cardiovascular event death in patients with peritoneal maintenance dialysis

作　　者：李静[1] 李洛华 蒋红樱[1] 董云萍 李玉凤[1] LI Jing;LI Luo-hua;JIANG Hong-ying;DONG Yun-ping;LI Yu-feng(Department of Nephrology,Second Hospital of Kunming University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院肾内科,昆明650101

出　　处：《临床肾脏病杂志》2020年第2期114-120,共7页Journal Of Clinical Nephrology

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项资金项目[2017FE468(-202),2017FE468(-157)];昆明医科大学研究生创新基金资助项目(2019S166)。

摘　　要：目的探讨血清总胆红素(total bilirubin,TBIL)水平与维持性腹膜透析患者全因死亡、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2013年1月1日至2015年12月31日在昆明医科大学第二附属医院肾内科置管并开始腹膜透析3个月及以上患者126例。收集患者的人口学资料、基线临床及实验室检查资料。所有患者随访至2018年12月31日。按照血清TBIL二分位数水平分为两组。采用Kaplan-Meier法比较两组患者的生存率,COX回归模型分析血清TBIL与全因死亡及心血管事件死亡的相关性。对各研究因素与血清TBIL进行Spearman相关分析。结果本研究共纳入126例腹膜透析患者,患者年龄是(52.8±13.5)岁,男性83例(65.9%)。透析龄25(13,39)个月。42例患者在随访期间死亡。低血清TBIL组全因死亡率为43.1%(28/65),高血清TBIL组全因死亡率为23.0%(14/61),差异有统计学意义(P=0.017)。两组间的血清TBIL、BUN、肌酐、eGFR、磷、钙磷乘积水平差异均有统计学意义。而年龄、性别、合并高血压、收缩压、舒张压、合并糖尿病、合并心力衰竭、合并左心室肥厚、合并冠心病、合并脑血管意外、合并HBV、合并HCV、透析龄、血清白细胞、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、谷氨酰基转移酶、总胆汁酸、尿酸、铁、总胆固醇、三酰甘油、白蛋白、血糖、红细胞压积、C反应蛋白、甲状旁腺素两组间差异均无统计学意义。Kaplan-Meier生存曲线显示,血清TBIL≤5.9 mmol/L组患者的生存率明显低于TBIL>5.9 mmol/L组(P=0.001)。充分校正的多因素COX回归分析显示,低血清TBIL是持续性腹膜透析患者全因死亡(HR=2.85595%CI:1.476~5.524,P=0.002)的独立危险因素,与心血管事件死亡相关(HR=3.501195%CI:1.442~8.498,P=0.006)。结论TBIL与持续不卧床腹膜透析患者的全因死亡风险及心血管死亡风险相关。Objective To investigate the correlation between serum total bilirubin level and all-cause mortality in peritoneal maintenance dialysis patients.Methods A single-center,retrospective and cohort study was conducted.A total of 126 patients with peritoneal dialysis,performed for 3 months or more in the department of nephropathy,second affiliated hospital of kunming medical university from January 1,2013 to December 31,2015,were enrolled.Demographic data,baseline clinical and laboratory test data from these patients were collected.All patients were followed up until 31 December 2018.The patients were divided into two groups according to the level of serum total bilirubin binary.Kaplan-Meier method was used to compare the survival rates of the two groups.COX regression model was used to analyze the correlation between serum total bilirubin and all-cause mortality and cardiovascular event mortality.Spearman correlation analysis was used to analyze the influencing factors of low serum total bilirubin level.Results A total of 126 patients with continuous peritoneal dialysis were enrolled in this study.The age of the patients was(52.8±13.5)and 83 of them were males(65.9%).Dialysis age was 25(13,39)months.42 patients died during the follow-up period.The all-cause mortality rate of the low serum total bilirubin group was 43.1%(28/65),and that of the high serum total bilirubin group was 23.0%(14/61),with statistically significant difference(P=0.017).There were statistically significant differences in serum total bilirubin(TBIL),urea nitrogen(BUN),creatinine(CREA),eGFR,phosphorus,calcium and phosphorus product between the two groups.Age,sex,hypertension,systolic pressure,diastolicpressure,diabetes mellitus,heart failure,left ventricular hypertrophy,coronary heart disease,cerebrovascular accident,HBV,HCV,dialysis age,serum leukocyte,ALT,AST,ALP,GGT,TBA,uric acid,iron,total cholesterol,triglyceride,albumin,blood sugar,hematocrit,C-reactive protein and parathyroid hormone had differences between the two groups with no statistic

关 键 词：腹膜透析 血清总胆红素 全因死亡 心血管事件死亡 

分 类 号：R692.5[医药卫生—泌尿科学]