探讨血液透析患者刚进入透析时及透析后一年血尿酸水平与全因死亡率的关系  

The research of the relationship between serum uric acid level and all-cause mortality at the beginning of maintenance hemodialysis and one year after diagnosis in hemodialysis patients

作　　者：段瑞秋 赵伟[1] 赵海丹 DUAN Rui-qiu;ZHAO Wei;ZHAO Hai-dan(Department of nephrology,Shougang Hospital of Peking University,Beijing 100144,China)

机构地区：[1]北京大学首钢医院肾内科,北京100144

出　　处：《临床肾脏病杂志》2020年第8期653-656,共4页Journal Of Clinical Nephrology

摘　　要：目的研究单中心的维持性血液透析(maintenance hemodialysis,MHD)患者刚进入透析时及透析后1年的平均血尿酸水平与全因死亡率的关系。方法回顾性的队列研究,观察122例终末期肾脏病患者,观察期5年,收集其刚进入透析时血生化资料以及透析后3个月、6个月、9个月及1年的平均血尿酸、白蛋白、血钙、血磷、血红蛋白等资料,分析其血尿酸变化趋势,根据不同时期血尿酸水平,分别将患者分为高尿酸组(男性>420μmol/L,女性>360μmol/L)、正常尿酸组(男性≤420μmol/L,女性≤360μmol/L),使用Kaplan-Meier分析不同时期的高、低尿酸组间全因死亡率的差异,使用多因素COX回归分析高、低血尿酸是否为全因死亡的独立危险因素。结果5年观察期间122例患者死亡35例,病死率为28.7%,刚进入透析时的血尿酸水平为(456±121)μmol/L,透析后1年内为(409±76)μmol/L,较前显著下降,差异有统计学意义(P<0.05)。以刚进入透析时血尿酸水平分组,高尿酸组与低尿酸组比较,全因死亡率差异无统计学意义(P=0.125);以透析后1年的平均血尿酸分组,高尿酸组较低尿酸组全因死亡率降低(P=0.004)。多因素COX回归分析提示矫正了年龄、性别、白蛋白、血肌酐及Kt/V等因素后,高尿酸是全因死亡的保护因素,其风险比例是正常尿酸的0.320倍,同时高尿酸组较低尿酸组患者年龄小、血肌酐水平高,差异有统计学意义。结论终末期肾病的患者刚进入血液透析时血尿酸水平高,透析后1年内可达到稳定,以刚进入透析时的尿酸分组,高、低尿酸组病死率之间差异无统计学意义,以透析后1年内的平均血尿酸分组,高尿酸组有更高的生存率,可能与其营养状态较好有关。Objective To study the relationship between average serum uric acid level and all-cause mortality in maintenance hemodialysis patients at a single center at the beginning of dialysis and 1 year after dialysis.Methods A retrospective cohort study was conducted to observe 122 patients with end-stage kidney disease.The observation period was 5 years.The data of average serum uric acid,albumin,serum calcium,serum phosphorus,hemoglobin and so on were collected at the beginning of dialysis and 3 months,6 months,9 months and 1 year after dialysis.The change trend of serum uric acid was analyzed.According to the levels of uric acid in different periods,the patients were divided into hyperuricemia group(male>420μmol/L,female>360μmol/L)and normal uric acid group(male≤420μmol/L,female≤360μmol/L).Kaplan-Meier was used to analyze the difference of all-cause mortality between the high and normal uric acid groups in different periods,and COX regression analysis was used to analyze whether uric acid level is an independent risk factor for all-cause death.Results During the 5-year observation 35 of 122 patients died,with a mortality rate of 28.7%.The average serum uric acid level at the beginning of hemodialysis was(456±121)μmol/L,and the average serum uric acid level one year after dialysis was(409±76)μmol/L,with statistically significant difference(P<0.05).According to the level of uric acid at the beginning of dialysis,there was no difference in all-cause mortality between high uric acid group and normal uric acid group(P=0.125).According to the mean uric acid level one year after hemodialysis,the all-cause mortality of the high uric acid levelgroup was lower than the normal uric acid levelgroup(P=0.004).Multivariate COX regression analysis suggested that after rectifying for age,sex,albumin,creatinine and Kt/V,hyperuricemia was an independent protective factor for all-cause death,and its odd ratio was 0.320 times the normal uric acid.At the same time,the patients in the high uric acid group are younger and the ser

关 键 词：血尿酸 血液透析 全因死亡率 

分 类 号：R692.5[医药卫生—泌尿科学]