血清尿酸水平与维持性血液透析患者死亡风险的相关性  

Relationship between serum uric acid and mortality in maintenance hemodialysis patients

作　　者：黄英 曹学森 滕杰 HUANG Ying;CAO Xuesen;TENG Jie(Department of Nephrology,Zhongshan Hospital(Xiamen Branch),Fudan University,Xiamen 361015,Fujian,China;Nephrology Clinical Quality Control Center of Xiamen,Xiamen 361015,Fujian,China;Department of Nephrology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院厦门医院肾内科,厦门361015 [2]厦门市肾病专业质量控制中心,厦门361015 [3]复旦大学附属中山医院肾内科,上海200032

出　　处：《中国临床医学》2024年第3期420-427,共8页Chinese Journal of Clinical Medicine

基　　金：2023年福建省临床重点专科建设项目;厦门市科技计划项目(3502Z20194030)

摘　　要：目的探讨血清尿酸(serum uric acid,SUA)水平对维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡率和心脑血管疾病死亡率的影响。方法回顾性收集2015年1月1日至2016年12月31日在复旦大学附属中山医院行维持性血液透析患者的临床资料,根据SUA水平三分位值将患者分为低SUA组(SUA≤399μmol/L)、中SUA组(SUA 400~460μmol/L)、高SUA组(SUA≥461μmol/L),比较3组患者临床资料和实验室检查结果。采用Kaplan-Meier法绘制生存曲线,log-rank检验比较3组患者生存率。采用多元Cox回归模型分析MHD患者SUA水平与全因死亡率、心脑血管疾病死亡率的关系。结果共入选436例MHD患者,低SUA组149例、中SUA组144例、高SUA组143例。中位随访时间59.7(38.4,60.9)个月,随访期间130例患者死亡,其中90例(69.2%)死于心脑血管疾病。Kaplan-Meier生存分析显示,低SUA组患者总生存率和心脑血管疾病生存率低于中SUA组和高SUA组。Cox回归分析显示,校正年龄、性别、合并症等因素后,SUA水平每升高10μmol/L,患者全因死亡风险下降2.6%(HR=0.974,95%CI 0.952~0.996,P=0.022),心脑血管疾病死亡风险下降3.7%(HR=0.963,95%CI 0.937~0.991,P=0.008);低SUA组患者的全因死亡(HR=1.841,95%CI 1.138~2.979,P=0.013)和心脑血管疾病死亡(HR=2.353,95%CI1.288~4.300,P=0.005)风险高于高SUA组。结论低SUA水平与MHD患者全因死亡和心脑血管疾病死亡独立相关。ObjectiveTo investigate the effect of serum uric acid(SUA)on all-cause mortality and cardio-cerebrovasculardiseasesmortality in maintenancehemodialysis(MHD)patients.MethodsClinicaldata wereretrospectivelycollected from MHD patients in Zhongshan Hospital,Fudan University from January 1,2015,to December 31,2016.The patientswere categorized into low SUA group(SUA≤399μmol/L),medium SUA group(SUA 400-460μmol/L),and high SUAgroup(SUA≥46lμmol/L)according to the tertiles of SUA level.The clinical data and laboratory examination results were comparedamong the three groups.The survival curves were plotted by Kaplan-Meier,and log-rank test were used to compare the survival ratesamong the three groups.Multivariate Coxregression was used to analyze the associations between SUA and all-cause mortality andcardio-cerebrovasculardiseasesmortality inMHDpatients.ResultsAtotalof436MHDpatients wereenrolled,including149inlow SUA group,144 in medium SUA group,and 143 in high SUA group.The median fllow-up time was 59.7(38.4,60.9)months.During the follow-up,130 deaths were recorded,of which 90(69.2%)were due to cardio-crebrovascular diseases.Kaplan-Meiersurvivalanalysis showedthat theall-cause survivalrate andcardio-cerebrovasculardiseases survivalrateofpatients inlow SUAgroup werelower than those inmedium SUAgroupandhighSUAgroup(P<0.05).Ateradjustingforagegender,comorbidities andotherfactors,themultivariate Coxregression analysisshowedthat theriskofall-causemortality inpatients decreased by2.6%(HR=0.974,95%CI0.952-0.996,P=0.022)and the risk of cardio-cerebrovascular diseases mortality decreased by3.7%(HR=0.963,95%CI0.937-0.991,P=0.008)foreach 10μmo/L increase in SUA level.The risks of all-cause mortality and cardiocerebrovascular diseases mortality were significantly higher in low SUA group compared to high SUA group(HR=1.841,95%CI1.138-2.979,P=0.013;HR=2.353,95%CI1.288-4.300,P-0.005).ConclusionsLow SUA level is independently associated withall-cause mortality and cardio-cerebrovascular diseases mortality in MHD patients.

关 键 词：血液透析 尿酸 全因死亡 心脑血管疾病死亡 

分 类 号：R692[医药卫生—泌尿科学]