总胆红素与持续不卧床腹膜透析患者死亡的相关性  

The association between serum total bilirubin and mortality in patients with continuous ambulatory peritoneal dialysis

作　　者：陈蓓蕾 马爽[1] 张丽洁 刘栋[1] 肖静[1] 赵占正[1] CHEN Bei-lei;MA Shuang;ZHANG Li-jie;LIU Dong;XIAO Jing;ZHAO Zhanzheng(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肾脏内科,郑州450052

出　　处：《中国血液净化》2021年第1期24-29,共6页Chinese Journal of Blood Purification

基　　金：国家自然科学基金青年基金(81400763)。

摘　　要：目的探讨血清总胆红素(total bilirubin,TBIL)水平与持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者全因死亡及心血管疾病(cardiovascular disease,CVD)死亡的相关性。方法回顾性分析2012年9月1日至2019年5月31日于郑州大学第一附属医院行CAPD治疗的患者,随访至2019年8月31日。收集并记录患者基线人口学资料和实验室指标。根据基线血清TBIL水平的三分位数,将患者分为低胆红素组(≤4.0μmol/L),中胆红素组(4.0~5.4μmol/L)和高胆红素组(>5.4μmol/L)。采用Kaplan-Meier生存曲线比较3组患者生存率;采用COX回归模型分析患者全因死亡及CVD死亡的危险因素。结果本研究共纳入217例CAPD患者,中位年龄45(35.5,52.0)岁,其中男性136例(62.7%),总体中位生存时间为70(37,>81)月,低胆红素组(72例)、中胆红素组(75例)和高胆红素组(70例)的中位生存时间分别为>75(56,>75)月、63(28,>81)月和58(30,70)月。3组患者在舒张压、白蛋白、血镁、白细胞计数、点式总蛋白、左心室径、总尿素清除指数(total urea clearance index,Kt/V)、合并糖尿病的比例方面的差异均有统计学意义(均P<0.05)。Kaplan-Meier生存曲线显示,低胆红素组的生存率较高(P<0.05)。充分校正的多因素COX回归分析显示,低血清TBIL水平是CAPD患者全因死亡(HR=0.365,95%CI:0.140~0.952,P=0.039)及CVD死亡(HR=0.208,95%CI:0.051~0.858,P=0.030)的独立保护因素。结论血清TBIL水平与CAPD患者的全因死亡及CVD死亡风险相关,可作为判断CAPD患者预后的有价值指标。Objective To explore the relationship between serum total bilirubin(TBIL)level and allcause mortality and cardiovascular disease(CVD)-related mortality in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods We reviewed patients undergoing CAPD at the First Affiliated Hospital of Zhengzhou University from September 1,2012 to May 31,2019.They were followed up until August 31,2019.Baseline demographics and laboratory test results were collected.Patients were divided into three groups according to baseline serum TBIL:low bilirubin group(≤4.0μmol/L),moderate bilirubin group(4.0~5.4μmol/L),and high bilirubin group(>5.4μmol/L).Kaplan-Meier survival curve was used to compare the survival rates of the three groups.Cox regression model was used to evaluate the risk factors for all-cause mortality and CVD-related mortality.Results A total 217 CAPD patients were enrolled in this study,with the median age of 45(35.5,52)years old and 136(62.7%)males.The overall median survival time was 70(37,>81)months.The median survival periods of low bilirubin group(n=72),moderate bilirubin group(n=75)and high bilirubin group(n=70)were>75(56,>75)months,63(28,>81)months and 58(30,70)months,respectively.There were statistical differences in diastolic blood pressure,albumin,blood magnesium,white blood cells,dot total protein,left ventricular diameter,total urea clearance index(Kt/V),and proportion of diabetes among the three groups(R<0.05,respectively).Kaplan-Meier survival curves showed higher survival rate in low bilirubin group(R<0.05).After adequate adjustment,multivariate Cox regression analysis showed that low serum TBIL level was an independent protective factor for all-cause mortality(HR=0.365,95%CI:0.140~0.952,R=0.039)and CVD-related mortality(HR=0.208,95%CI:0.051~0.858,R=0.030)in CAPD patients.Conclusion Serum TBIL is associated with mortality risk of all-cause mortality and CVD-related mortality in CAPD patients and can be a valuable indicator for the prognosis of CAPD patients.

关 键 词：腹膜透析 胆红素 死亡率 心血管疾病 

分 类 号：R459.5[医药卫生—治疗学]