慢性肾脏病患者二尖瓣反流的危险因素及预后分析  

Risk factors and prognostic analysis of mitral regurgitation in patients with chronic kidney disease

作　　者：安然 李文[1] 姚峥[1] 吴雷云[1] 付文静[1] 林娜[1] 张爱华 An Ran;Li Wen;Yao Zheng;Wu Leiyun;Fu Wenjing;Lin Na;Zhang Aihua(Department of Nephrology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院肾内科,北京100053

出　　处：《中华肾脏病杂志》2024年第12期931-939,共9页Chinese Journal of Nephrology

摘　　要：目的探讨慢性肾脏病(chronic kidney disease,CKD)患者发生二尖瓣反流(mitral regurgitation,MR)的危险因素及其对预后的影响。方法本研究为回顾性单中心研究。收集2018年1月1日至2019年12月31日于首都医科大学宣武医院肾内科住院治疗且进行心脏超声心动图检查的CKD患者的临床资料,并对患者进行随访,随访截止时间为2021年11月1日,终点事件为全因死亡。采用Logistic回归分析CKD患者发生MR的相关因素,采用Kaplan⁃Meier生存分析绘制生存曲线,生存率的比较采用Log⁃rank检验,多因素Cox回归分析CKD患者死亡的风险因素。结果本研究共纳入555例CKD患者,有262例发生MR,其中轻度212例(80.9%)、中度44例(16.8%)、重度6例(2.3%)。CKD 1~5期患者MR的患病率分别为21.9%、33.0%、45.9%、51.9%和64.6%,中重度MR的患病率分别为0、5.6%、7.4%、10.1%和15.9%。多因素Logistic回归分析显示男性(OR=1.579,95%CI 1.008~2.476,P=0.046)、合并慢性心脏疾病(OR=2.263,95%CI 1.398~3.662,P=0.001)、CKD 4~5期(以CKD 1~3期为参照,OR=1.744,95%CI 1.007~3.019,P=0.047)、血红蛋白降低(OR=0.985,95%CI 0.975~0.996,P=0.006)是CKD患者发生MR的相关因素。Kaplan⁃Meier生存分析显示MR组全因死亡率高于非MR组(Log⁃rank,χ^(2)=8.094,P=0.004)。多因素Cox回归分析显示年龄增加(HR=1.072,95%CI 1.042~1.104,P<0.001)、血磷升高(HR=2.782,95%CI 1.122~6.895,P=0.027)、MR(HR=1.962,95%CI 1.002~3.839,P=0.049)和血清白蛋白降低(HR=0.927,95%CI 0.886~0.970,P=0.001)是CKD患者全因死亡的独立相关因素。结论MR的总体患病率及中重度MR的患病率随着CKD的进展呈增加趋势。男性、合并慢性心脏疾病、CKD 4~5期、血红蛋白降低为CKD患者发生MR的危险因素。MR是CKD患者全因死亡的独立危险因素。Objective To investigate the risk factors and prognosis of mitral regurgitation(MR)in patients with chronic kidney disease(CKD).Methods Clinical data were collected from CKD patients who were hospitalized at the Department of Nephrology,Xuanwu Hospital,Capital Medical University,from January 1,2018,to December 31,2019,and underwent echocardiography.Patients were followed up until November 1,2021,with the endpoint being all-cause mortality.Logistic regression was used to analyze the risk factors of MR in CKD patients.Kaplan-Meier survival analysis was performed to plot the survival curve,with the Log‐rank test comparing the survival rate.Multivariate Cox regression analysis was used to identify the risk factors of death in CKD patients.Results It was a retrospective single-center study.A total of 555 CKD patients were included,with 262 patients developing MR.Of whom,212 patients had mild MR(80.9%),44 patients had modreate MR(16.8%),6 patients had severe MR(2.3%).The prevalence of MR among patients with CKD stages 1 to 5 was 21.9%,33.0%,45.9%,51.9%,and 64.6%,and the prevalence of moderate to severe MR was 0,5.6%,7.4%,10.1%,and 15.9%.Multivariate logistic regression analysis revealed that male sex(OR=1.579,95%CI 1.008-2.476,P=0.046),presence of chronic heart disease(OR=2.263,95%CI 1.398-3.662,P=0.001),CKD stage 4-5(with CKD stage 1-3 as reference,OR=1.744,95%CI 1.007-3.019,P=0.047),and decreasing hemoglobin levels(OR=0.985,95%CI 0.975-0.996,P=0.006)were the associated factors for MR in CKD patients.Kaplan-Meier survival analysis indicated higher all-cause mortality(Log-rank,χ^(2)=8.094,P=0.004)in the MR group compared to the non-MR group.Multivariate Cox regression analysis showed that increasing age(HR=1.072,95%CI 1.042-1.104,P<0.001),elevating blood phosphorus(HR=2.782,95%CI 1.122-6.895,P=0.027),MR(HR=1.962,95%CI 1.002-3.839,P=0.049)and decreasing albumin(HR=0.927,95%CI 0.886-0.970,P=0.001)were independent associated factors for all-cause death in CKD patients.Conclusions The overall prevalence of MR and the pr

关 键 词：二尖瓣闭锁不全 肾功能不全 慢性 危险因素 预后 二尖瓣反流 

分 类 号：R692[医药卫生—泌尿科学] R542.51[医药卫生—外科学]