血镁水平与腹膜透析患者心血管疾病死亡及全因死亡的关系  

Association of serum magnesium with cardiovascular mortality and all-cause mortality in peritoneal dialysis patients

作　　者：官继超[1] 龚屠健 龚淑文[1] 张素梅 沈水娟[1] Guan Jichao;Gong Tujian;Gong Shuwen;Zhang Sumei;Shen Shuijuan(Department of Nephrology,Shaoxing People's Hospital(Shaoxing Hospital,Zhejiang University School of Medicine),Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院肾内科(浙江大学绍兴医院),绍兴312000

出　　处：《中华肾脏病杂志》2020年第9期688-695,共8页Chinese Journal of Nephrology

摘　　要：目的探讨腹膜透析(PD)患者血镁水平与心血管疾病(CVD)死亡和全因死亡的相关性。方法回顾性收集2013年1月1日至2019年7月31日在绍兴市人民医院开始接受PD治疗患者的临床资料。根据血镁(Mg)水平分为对照组(Mg≥0.7 mmol/L)与低镁组(Mg<0.7 mmol/L),比较两组患者基线临床资料、生化指标、合并症、用药情况和临床结局的差异。Logistic回归法分析PD患者发生低镁血症的危险因素,Kaplan-Meier生存曲线和Fine-Gray模型法比较两组患者累积生存率的差异;Cox回归模型和竞争风险模型法分析PD患者全因死亡和CVD死亡的危险因素。结果共381例PD患者入选本研究,对照组321例,低镁组60例,中位随访时间27(15,43)个月。两组患者在血清白蛋白、血镁、血磷、全段甲状旁腺素、低密度脂蛋白胆固醇、超敏C反应蛋白(hsCRP)、4 h腹膜透析液肌酐/血肌酐比值(4 h D/Pcr)等项目上的差异有统计学意义(均P<0.05),CVD是PD患者死亡的主要原因。多因素logistic回归分析结果显示,低血清白蛋白(OR=0.901,95%CI 0.831~0.976,P=0.011)、低血磷(OR=0.217,95%CI 0.080~0.591,P=0.003)、高hsCRP(OR=1.276,95%CI 1.066~1.528,P=0.008)、高4 h D/Pcr(OR=1.395,95%CI 1.014~1.919,P=0.041)是患者存在低镁血症的独立危险因素。Kaplan-Meier生存曲线分析结果显示,低镁组累积患者生存率显著低于对照组(Log-rankχ2=5.388,P=0.020),Fine-Gray模型分析结果显示低镁组累积CVD生存率显著低于对照组(Gray=6.915,P=0.009)。多因素校正的Cox回归模型和竞争风险模型分析结果显示,血镁作为连续性变量时,血镁水平较高是PD患者全因死亡和CVD死亡的保护性因素(分别HR=0.137,95%CI 0.020~0.946,P=0.044;SHR=0.037,95%CI 0.002~0.636,P=0.023);血镁作为分类变量时,低镁血症是PD患者全因死亡和CVD死亡的独立危险因素(分别HR=1.864,95%CI 1.044~3.328,P=0.035;SHR=2.117,95%CI 1.147~3.679,P=0.029)。结论低镁血症易存在于低血清白蛋白、低�Objective To investigate the association of serum magnesium with cardiovascular disease(CVD)and all-cause mortality in peritoneal dialysis patients.Methods A retrospective study was performed in patients who initiated peritoneal dialysis from January 1,2013 to July 31,2019 in the Shaoxing People's Hospital.According to the standard of serum magnesium,the patients were divided into control group(Mg≥0.7 mmol/L)and low-magnesium group(Mg<0.7 mmol/L).The differences in baseline biochemical variables,comorbidities,medications,and clinical outcomes between the two groups were compared.Logistic regression was used to analyze the related factors of hypomagnesemia.Kaplan-Meier survival analysis and Fine-Gray model were used to compare the difference in cumulative survival rate between the two groups.Cox regression model and competitive risk model were used to analyze the risk factors of all-cause mortality and CVD mortality.Results A total of 381 peritoneal dialysis patients were enrolled in this study.Among them,321 patients were in control group and 60 patients in low-magnesium group.The total median follow-up time was 27(15,43)months.There were significant differences in serum albumin,magnesium,phosphorus,intact parathyroid hormone,low-density lipoprotein chloesterol,high sensitivity C-reactive protein and 4-hour dialysate-to-plasma creatinine(4 h D/Pcr)between the two groups.CVD was the main cause of death in patients on peritoneal dialysis.Multivariate logistic regression analysis showed that hypoalbuminemia(OR=0.901,95%CI 0.831-0.976,P=0.011),hypophosphatemia(OR=0.217,95%CI 0.080-0.591,P=0.003),higher hsCRP(OR=1.276,95%CI 1.066-1.528,P=0.008),and higher 4 h D/Pcr(OR=1.395,95%CI 1.014-1.919,P=0.041)were independent risk factors for patients with hypomagnesemia.Kaplan-Meier survival curve analysis showed the cumulative survival rate of patients in low-magnesium group was significantly lower than that of control group(Log-rankχ2=5.388,P=0.020).Fine-Gray model analysis showed the cumulative CVD survival rate of low-m

关 键 词：镁 腹膜透析 心血管疾病 死亡率 

分 类 号：R692.5[医药卫生—泌尿科学] R54[医药卫生—外科学]