维持性血液透析患者首次透析血清白蛋白水平与预后的相关性研究  

Correlation between first dialysis serum albumin level and prognosis in maintenance hemodialysis patients

作　　者：马荣 毛楠[2] 肖祥[2] 谢春鹏 奉娅 MA Rong;MAO Nan;XIAO Xiang;XIE Chun-peng;FENG Ya(Department of Endocrinology and Nephrology,Xindu District People's Hospital,Chengdu 610500,China;Department of Nephrology,the First Affiliated Hospital of Chengdu Medical University,Chengdu 610500,China)

机构地区：[1]成都市新都区人民医院内分泌肾脏科,成都610500 [2]成都医学院第一附属医院肾脏内科,成都610500

出　　处：《中国血液净化》2025年第2期108-112,共5页Chinese Journal of Blood Purification

基　　金：2022年成都医学院科技基金立项项目(CYZYB22-02)。

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者首次透析血清白蛋白(ALB)水平与预后的相关性。方法回顾性分析2009年1月─2022年10月成都医学院第一附属医院血液净化中心MHD患者,共纳入并评估了1000例,收集患者的人口统计学及临床特征资料,研究终点为全因死亡。采用R语言获得ALB最佳截点值,根据ALB截点值将患者分为高ALB组(n=808)和低ALB组(n=192),分析不同ALB水平患者的临床特征以及ALB与临床指标的相关性,评估ALB对MHD患者的预后影响。结果ALB与血红蛋白(r=0.176,P<0.001)、Kt/V(r=0.217,P<0.001)、URR(r=0.192,P<0.001)、血肌酐(r=0.259,P<0.001)、血钙(r=0.225,P<0.001)、血磷(r=0.225,P<0.001)、PTH(r=0.196,P<0.001)呈正相关关系,与年龄(r=-0.147,P=0.001)、C反应蛋白(r=-0.279,P<0.001)、葡萄糖(r=-0.145,P<0.001)呈负相关关系。随访期间1000例MHD患者中164(16.40%)例发生死亡,除了年龄(HR=1.022,95%CI:1.010~1.034,P<0.001)、PTH(HR=0.999,95%CI:0.998~1.000,P=0.046)、尿素清除指数、尿素减少率以外,ALB是MHD患者死亡的独立预测因子(HR=0.940,95%CI:0.904~0.977,P=0.002)。结论首次透析低ALB水平是MHD患者预后不良的独立危险因素。首次透析ALB在39.8 g/L以上的MHD患者的预后更好。临床医生应该重视MHD患者的首次透析ALB水平,MHD患者首次透析ALB水平越高其全因死亡风险越低。Objective This study aimed to explore the clinical characteristics of first dialysis serum albumin(ALB)level in patients with maintenance hemodialysis(MHD)and its influence on prognosis,and to analyze the value in predicting all-cause death in patients with MHD.Methods A retrospective analysis was performed in the Blood Purification Center from January 20009 to October 2022,and 1000 patients with MHD were finally included.The demographic and clinical characteristics of the patients were collected.The study endpoint was all-cause death.The optimal cut-off point of ALB is obtained by using R software.The patients were divided into groups(high ALB group and low ALB group)according to the ALB cut-off value.The clinical characteristics of patients with different ALB levels and the correlation between ALB and clinical indicators were analyzed,and the influence of ALB on the prognosis of MHD patients was evaluated.Results ALB and hemoglobin(r=0.176,P<0.001),Kt/V(r=0.217,P<0.001),URR(r=0.192,P<0.001),blood creatinine(r=0.259,P<0.001),blood calcium(r=0.225,P<0.001),blood phosphorus(r=0.225,P<0.001),PTH(r=0.196,P<0.001)are positively correlated,and negatively correlated with age(r=-0.147,P=0.001),C-reactive protein(r=-0.279,P<0.001),and glucose(r=-0.145,P<0.001).During the follow-up period,164 patients(16.40%)died,age(HR=1.022,95%CI:1.010~1.034,P<0.001),PTH(HR=0.999,95%CI:0.998~1.000,P=0.046),urea clearance index,urea reduction rate,and ALB level is an independent predictor of mortality in MHD patients(HR=0.940,95%CI:0.904~0.977,P=0.002).Conclusion Low ALB level on first dialysis is an independent risk factor of all-cause death in MHD patients.MHD patients with ALB level above 39.8g/L on first dialysis have a better prognosis.Clinicians should pay attention to the ALB level of MHD patients on first dialysis.The higher the ALB level of MHD patients on first dialysis,the lower the risk of all-cause death.

关 键 词：血清白蛋白 维持性血液透析 预后 风险因子 

分 类 号：R459.5[医药卫生—治疗学]