中老年维持性血液透析患者体重指数和腰围与全因死亡风险的相关关系  

Association of body mass index and waist circumference with risk of all-cause mortality in middle-aged and elderly patients receiving maintenance hemodialysis

作　　者：石志华 郭一丹 张春霞 周晓玲 叶鹏鹏 罗洋 Shi Zhihua;Guo Yidan;Zhang Chunxia;Zhou Xiaoling;Ye Pengpeng;Luo Yang(Department of Nephrology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Division of Injury Prevention and Mental Health National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京世纪坛医院肾内科,北京100038 [2]中国疾病预防控制中心慢性和非传染性疾病预防控制中心,北京100053

出　　处：《中华肾脏病杂志》2023年第11期809-814,共6页Chinese Journal of Nephrology

基　　金：国家重点研发计划匹配项目(Z161100002616005);首都卫生发展科研专项项目(首发2022-2-2081)。

摘　　要：目的探讨中老年维持性血液透析(maintenance hemodialysis,MHD)患者体重指数(body mass index,BMI)及腰围与全因死亡率的关系。方法采用前瞻性队列研究的方法,收集北京市2017年4—6月11家血液透析中心年龄≥50岁MHD患者的临床资料。按照患者基线BMI值将其分为BMI偏低组(BMI<18.5 kg/m^(2))、BMI正常组(18.5 kg/m^(2)≤BMI<24.0 kg/m^(2))、超重组(24.0 kg/m^(2)≤BMI<28.0 kg/m^(2))和肥胖组(BMI≥28.0 kg/m^(2));按基线腰围值将其分为中心型肥胖组(男≥85 cm,女≥80 cm)和腰围正常组(男<85 cm,女<80 cm)。采用Kaplan-Meier生存曲线比较各组患者全因死亡率的差异;多因素Cox回归模型法分析BMI和腰围与MHD患者全因死亡风险的相关性。结果该研究纳入中老年MHD患者613例,年龄(63.82±7.14)岁,女性258例(42.09%)。其中BMI偏低组46例(7.50%),BMI正常组303例(49.43%),超重组227例(37.03%),肥胖组37例(6.04%);中心型肥胖组346例(56.44%),腰围正常组267例(43.56%)。Kaplan-Meier生存曲线分析结果显示,BMI偏低组(Log-rank χ^(2)=13.571,P<0.001)和肥胖组(Log-rank χ^(2)=6.664,P=0.010)患者的全因死亡率均高于BMI正常组;中心型肥胖组患者全因死亡率高于腰围正常组(Log-rank χ^(2)=5.698,P=0.017)。多因素Cox回归分析结果显示,除了BMI偏低组和肥胖组(以BMI正常组为参照,分别HR=5.289,95%CI 2.318~12.067,P<0.001;HR=5.360,95%CI 2.088~13.760,P<0.001)外,BMI正常和超重合并中心型肥胖患者的全因死亡风险亦明显增高(以腰围正常组为参照,分别HR=2.605,95%CI 1.199~5.663,P=0.016;HR=1.787,95%CI 1.026~3.732,P=0.031)。结论 BMI较低和较高或合并中心型肥胖均与中老年MHD患者全因死亡风险增加独立相关。Objective To investigate the association between body mass index(BMI)and waist circumference(WC)with all-cause mortality in middle-aged and elderly patients receiving maintenance hemodialysis(MHD).Methods It was a prospective cohort study.The clinical data of MHD patients aged≥50 years old from eleven hemodialysis centers from April to June 2017 in Beijing were analyzed.The patients were divided into low BMI group[body mass index(BMI)<18.5 kg/m^(2)],normal BMI group(18.5 kg/m^(2)≤BMI<24.0 kg/m^(2)),overweight group(24.0 kg/m^(2)≤BMI<28.0 kg/m^(2))and obesity group(BMI≥28.0 kg/m^(2))by BMI,and central obesity group(male≥85 cm,female≥80 cm)and normal WC group(male<85 cm,female<80 cm)by WC.Kaplan-Meier survival analysis method was used to compare the difference of all-cause mortality between those groups.Multivariate Cox regression model was used to analyze the association of BMI and WC with all-cause mortality.Results A total of 613 MHD patients were enrolled,with age of(63.82±7.14)years old and 258(42.09%)females.There were 46(7.50%)patients in the low BMI group,303(49.43%)patients in the normal BMI group,227(37.03%)patients in the overweight group and 37(6.04%)patients in the obesity group.In addition,346(56.44%)patients were categorized as central obesity.Kaplan-Meier survival analysis results showed that the all-cause mortality rates of low BMI group(log-rank χ^(2)=13.571,P<0.001)and obesity group(log-rank χ^(2)=6.664 P=0.010)were higher than that of normal BMI group,and the all-cause mortality rate of central obesity group was higher than that of normal WC group(log-rank χ^(2)=5.698,P=0.017).Multivariate Cox regression analysis results showed that,besides the low BMI group and obesity group(with normal BMI group as a reference,HR=5.289,95%CI 2.318-12.067,P<0.001;HR=5.360,95%CI 2.088-13.760,P<0.001,respectively),normal BMI and overweight combined with central obesity were also independently correlated with all-cause mortality(with normal WC group as a reference,HR=2.605,95%CI 1.199-5.663,P=0.016

关 键 词：肾透析 人体质量指数 腰围 肥胖 危险因素 死亡率 

分 类 号：R692.5[医药卫生—泌尿科学]