天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (5): 517-522.doi: 10.11958/20212174

• 临床研究 • 上一篇    下一篇

血尿酸对维持性血液透析合并矿物质代谢紊乱患者预后的影响#br#

张春秀，李晶，蒋红樱△，董云萍，李玉凤，贺婷，李萌   

  1. 昆明医科大学第二附属医院肾脏内科（邮编650000）
  • 收稿日期:2021-09-18 修回日期:2021-12-09 出版日期:2022-05-15 发布日期:2022-07-04
  • 基金资助:
    昆明医科大学第二附属医院肾脏内科（邮编650000）

The effect of serum uric acid on the prognosis of maintenance hemodialysis patients with mineral metabolism disorders

ZHANG Chunxiu, LI Jing, JIANG Hongying△, DONG Yunping, LI Yufeng, HE Ting, LI Meng   

  1. Department of Nephrology, the Second Affiliated Hospital of Kunming Medical University, Kunming 650000, China
  • Received:2021-09-18 Revised:2021-12-09 Published:2022-05-15 Online:2022-07-04

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摘要： 目的　探讨血尿酸（SUA）对维持性血液透析（MHD）合并矿物质代谢紊乱患者预后的影响。方法　选取行MHD合并矿物质代谢紊乱患者192例。根据患者的SUA水平分为Q1组（SUA≤363 μmol/L，47例）、Q2组（SUA 364~459 μmol/L，48例）、Q3组（SUA 460~559 μmol/L，49例）及Q4组（SUA≥560 μmol/L，48例）。比较4组患者临床资料，并对患者进行随访。采用Spearman法分析SUA与各指标的相关性，Kaplan-Meier法比较4组患者的生存率，Cox回归模型分析SUA对患者预后的影响。结果　与Q1组相比，Q2、Q3、Q4组血肌酐（Scr）、尿素氮（BUN）、血磷（P）升高，估算肾小球滤过率（eGFR）、高密度脂蛋白胆固醇降低，Q2及Q4组白蛋白（ALB）升高（P＜0.05）；与Q2和Q3组相比，Q4组Scr、BUN、血P水平升高（P＜0.05）。SUA与ALB、BUN、Scr、血P、血镁（Mg）呈正相关，与血钙（Ca）呈负相关（P＜0.05）。患者平均随访时间16.0（11.0，23.8）个月，发生结局事件的患者共45例（23.4%），其中心血管疾病死亡患者22例（11.5%）。Kaplan-Meier生存曲线显示Q1组患者全因病死率及心血管疾病病死率较高（Log-rank χ2分别为9.707、7.912，P＜0.05）。单因素Cox回归分析显示低ALB、低血Mg、合并CVD为MHD合并矿物质代谢紊乱患者心血管疾病病死的危险因素，而较高尿酸（Q4组）为其保护因素（P＜0.05）。多因素Cox回归分析显示，高龄、低血Mg及合并心血管疾病为MHD合并矿物质代谢紊乱患者全因死亡的独立危险因素，而较高尿酸（Q3、Q4组）为其保护因素（P＜0.05）。结论　较高的SUA可以降低MHD合并矿物质代谢紊乱患者的全因病死率。

关键词: 肾透析, 矿物质, 代谢疾病, 预后, 尿酸, 维持性血液透析

Abstract: Objective　To investigate the effect of serum uric acid (SUA) on prognosis of patients with maintenance hemodialysis (MHD) complicated with mineral metabolism disorder. Methods　A total of 192 patients with MHD complicated with mineral metabolism disorder were selected. According to the level of SUA, patients were divided into the group Q1 (SUA≤363 μmol/L, n=47), the group Q2 (SUA 364-459 μmol/L, n=48), the group Q3 (SUA 460-559 μmol/L, n=49) and the group Q4 (SUA≥560 μmol/L, n=48). The clinical data were compared between the 4 groups. Patients were followed up. Spearman method was used to analyze the correlation between SUA and other index. Kaplan-Meier method was used to compare the survival rates of the 4 groups, and Cox regression model was used to analyze the effect of SUA on the prognosis of the patients. Results　Compared with the group Q1, serum creatinine (Scr), urea nitrogen (BUN) and blood phosphorus (P) were increased in the groups Q2, Q3 and Q4, glomerular filtration rate (eGFR) and high density lipoprotein (HDL-C) were decreased, and albumin (ALB) was increased in the groups Q2 and Q4 (P＜0.05). Compared with the groups Q2 and Q3, the levels of Scr, BUN and P were decreased in the group Q4 (P＜0.05). SUA was positively correlated with ALB, BUN, Scr, P, and magnesium (Mg), and negatively correlated with calcium (Ca) (P＜0.05). The mean follow-up time was 16.0 (11.0, 23.8) months. A total of 45 patients (23.4%) had outcome events, including 22 patients (11.5%) with cardiovascular death. Kaplan-Meier survival curve showed that the all-cause mortality and cardiovascular disease mortality were higher in the group Q1 (Log-rank χ2=9.707 and 7.912, P＜0.05). Univariate Cox regression analysis showed that low ALB, low blood Mg, and CVD were risk factors for cardiovascular disease death in MHD patients with mineral metabolism disorder, while higher uric acid (the Q4 groups) was its protective factor (P＜0.05). Multivariate Cox regression analysis showed that advanced age, low blood Mg and cardiovascular disease were independent risk factors for all-cause death in MHD patients with mineral metabolism disorder, while higher uric acid (the groups Q3,Q4) was its protective factor (P＜0.05). Conclusion　Higher SUA can reduce all-cause mortality in MHD patients with mineral metabolism disorders.

Key words: renal dialysis, minerals, metabolic diseases, prognosis, uric acid, maintenance hemodialysis

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