中国血液净化

›› 2011, Vol. 10 ›› Issue (8): 420-425.doi: 10.3969/j.issn.1671-4091.2011.08.00

• 临床研究 • 上一篇    下一篇

维持性血液透析患者白蛋白和C反应蛋白水平与预后的关系

张燕京 吴 华 陈献广　柴 毅   

  1. 卫生部北京医院肾内科
  • 收稿日期:2011-02-11 修回日期:1900-01-01 出版日期:2011-08-12 发布日期:2011-08-12
  • 通讯作者: 吴华

The relationship between serum albumin / CRP levels and prognosis in maintenance hemodialysis patients

ZHANG Yan-jing, WU Hua, CHEN Xian-guang, CHAI Yi   

  1. Department of Nephrology, Beijing Hospital, Beijing 100730, China
  • Received:2011-02-11 Revised:1900-01-01 Online:2011-08-12 Published:2011-08-12

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摘要：

目的 分析和探讨卫生部北京医院2008年血液透析患者血清白蛋白和C反应蛋白(C-reactive protein,CRP)水平及其与预后的关系。 方法 总结本院2008年93例在透患者的血清白蛋白及CRP水平，将93例患者按照CRP与白蛋白水平分组，截至2010年底，统计各组患者的死亡率，记录死亡原因，绘制生存曲线。 结果 2008年本院在透患者总体血清白蛋白水平有所改善，年初和年末平均值分别为(38.42±2.81)g/L和(39.41±2.77)g/L，差异有统计学意义(P=0.0020；男性各时点血清白蛋白平均值均优于女性，年末时男女分别为(39.56±3.26)g/L和(39.24±2.12)g/L；年末总达标率为91.0%；＜60岁组患者白蛋白达标率明显优于≥60岁组患者(χ2=6.746,P=0.014)。在透患者总体CRP水平逐渐下降，年初和年末分别为(0.53±0.46)mg/dl和(0.38±0.20)mg/dl，差异有统计学意义(t=2.276，P＜0.05)；CRP与白蛋白水平呈显著负相关关系(r=-0.238,P＜0.01)。患者死亡原因主要为感染性休克和心脑血管疾病(82.3%)。生存分析提示血清白蛋白和CRP均异常的患者死亡率最高，为66.7%，白蛋白异常组患者死亡率高于CRP异常组，分别为50.0%和18.8%，差异有统计学意义(χ2=72.563,P＜0.01)。 结论 2008年本院在透患者的血清白蛋白水平年末较年初有较大改善。男性各时点白蛋白水平均优于女性。＜60岁组患者白蛋白达标率明显优于≥60岁组。CRP与白蛋白水平呈显著负相关的关系，低白蛋白血症和较高CRP水平更影响血液透析患者的预后。

关键词: 血液透析, 血清白蛋白, C反应蛋白, 死亡率

Abstract:

Objective To summarize serum albumin and C-reactive protein (CRP) levels in hemodialysis patients treated in Beijing Hospital in 2008, and to analyze their effect on patients’ prognosis. Methods We summarized serum albumin and CRP levels in 93 hemodialysis patients treated in Beijing Hospital in 2008. The patients were divided into four groups based on their serum albumin and CRP levels. Mortality rate and cause of death before the end of 2010 in each group were recorded, and a survival curve was then derived. Results (a) Patients’ serum albumin level improved following treatment. At the beginning and the end of 2008, serum albumin level was 38.42±2.81g/L and 39.41±2.77g/L (P=0.002), respectively. Serum albumin level was higher in male patients than in female patients. At the end of 2008, serum albumin was 39.56±3.26g/L in male patients and was 39.24±2.12g/L in female patients, and the level was in the normal range in 91.0% patients. The percentage of normal serum albumin was higher in the patient group of <60 years old than in the group of >60 years old (χ2=6.746，P=0.014). (b) Serum CRP level decreased following hemodialysis. At the beginning and the end of 2008, serum CRP level was 0.53±0.46mg/dL and 0.38±0.20mg/dL, respectively (t=2.276, P＜0.05). Serum CRP correlated negatively with serum albumin (r=-0.238, P＜0.01). The major causes of death in this cohort were septic shock and cardiac-cerebro-vascular diseases (82.3%). Survival analysis demonstrated that the mortality rate was 66.7% in the group with abnormal albumin and CRP levels, 50.0% in the group with abnormal albumin level, and 18.8% in the group with abnormal CRP level (χ2=72.563，P=0.000). Conclusions Patients’ serum albumin level improved following hemodialysis. Serum albumin level was higher in male patients than in female patients. The percentage of normal serum albumin was higher in the patient group of <60 years old than in the group of >60 years old. Serum CRP correlated negatively with serum albumin. Mortality rate was higher in patients with hypoalbuminemia and higher serum CRP.

Key words: Serum albumin, CRP, Mortality