中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (06): 392-396.doi: 10.3969/j.issn.1671-4091.2017.06.009

• 临床研究 • 上一篇    下一篇

维持性血液透析患者C反应蛋白联合白蛋白与死亡相关

王丽莉,王铠   

  1. 北京民航总医院肾内科
  • 收稿日期:2017-03-10 修回日期:2017-04-19 出版日期:2017-06-12 发布日期:2017-06-14
  • 通讯作者: 王铠 wangkaicaac@126.com E-mail:wangkaicaac@126.com

C-reactive protein combined with serum albumin correlated with the mortality in maintenance hemodialysis patients

  • Received:2017-03-10 Revised:2017-04-19 Online:2017-06-12 Published:2017-06-14

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摘要： 目的探讨维持性血液透析(maintenance hemodialysis，MHD)患者C 反应蛋白(C reactive protein，CRP)联合白蛋白(albumin，ALB)与全因死亡的关系。方法收集2012 年1 月至2016 年12 月北京民航总医院在北京市血液净化质量控制和改进中心数据登记系统中规律血液透析患者的一般情况、生化指标以及预后，评估CRP、ALB 与全因死亡之间的关系。结果入选患者314 例,平均年龄(63.32±13.57)岁，透析龄65.00(43.75，100.00)个月，死亡患者88 例(28.03% )。CRP 阳性(≥3 mg/L)157 例(50.00%)，ALB 阳性(＜38g/L)126 例(40.13%)。CRP 联合ALB 将患者分为双阴性组109 例、单阳性组127例和双阳性组78 例，全因死亡分别占13.76%、26.77%和50.00%(χ2=29.766，P＜0.001)。Kaplan-Meier分析显示双阴性、单阳性、双阳性累积生存率依次降低(χ2=39.380，P＜0.001)。多因素COX 回归提示，年龄(HR=1.022，95% CI 1.001～1.045, P=0.044)、糖尿病(HR=1.665，95% CI 1.068～2.596,P=0.024)是全因死亡的危险因素，血肌酐(HR=0.998，95% CI 0.997～0.999,P=0.005)是保护因素。CRP 联合ALB 单阳性作为参考，双阳性是全因死亡的危险因素(HR=1.709,95% CI 1.027～2.843,P=0.039)。结论和单独CRP或ALB 相比，CRP 联合ALB 与死亡更相关，双阳性是全因死亡的独立危险因素。

关键词: 血液透析, C反应蛋白, 白蛋白, 死亡

Abstract: Objective To investigate C-reactive protein (CRP) combined with serum albumin (ALB) in the prediction of all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A total of 314 MHD cases treated in the period from Jan. 2012 to Dec. 2016 in the Hemodialysis Center of Civil Aviation General Hospital were registered in Beijing Hemodialysis Quality Control and Improvement Center Network. Their general information, laboratory results and outcomes were recruited. Results In the 314 MHD cases, the average age was 63.32±13.57 years, the dialysis vintage was 65.00 (43.75, 100.00) months, and 88 patients
(28.03%) died. CRP was positive (≥3 mg/L) in 157 cases (50.00%) and ALB was positive (＜38 g/L) in 126 cases (40.13%). According to CRP and ALB values, patients were divided into negative CRP and negative ALB group (n=109), positive CRP or positive ALB group (n=127), and positive CRP and positive ALB group (n=78); Statistical difference in all-cause mortality was found between the 3 groups (13.76%, 26.77% and 50.00% respectively; χ2=29.766, P＜0.001). Kaplan-Meier method showed that all- cause mortality was higher in patients with positive CRP and positive ALB than in patients with positive CRP or positive ALB, and was higher in patients with positive CRP or positive ALB than in patients with negative CRP and negative ALB (χ2=39.380, P＜0.001). Multivariate Cox regression showed that age (HR=1.022, 95% CI 1.001～1.045, P=0.044) and diabetes (HR=1.665, 95% CI 1.068～2.596, P=0.024) were the independent risk factors for allcause mortality, and serum creatinine was the independent protective factor (HR=0.998, 95% CI 0.997-0.999, P=0.005). If positive CRP or positive ALB group was used as a reference, positive CRP combined with positive ALB was the independent risk factor for all-cause mortality (HR=1.709, 95% CI 1.027～2.843, P=0.039). Conclusion C-reactive protein combined with serum albumin is closely related to all-cause mortality, i.e., positive CRP combined with positive ALB is the independent risk factor for all-cause mortality in MHD patients.

Key words: Hemodialysis, C-reactive protein, Serum albumin, mortality