中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (02): 94-98.doi: 10.3969/j.issn.1671-4091.2026.02.002

• 临床研究 • 上一篇    下一篇

改良肌酐指数纵向变化趋势对维持性血液透析患者全因死亡的影响

田荣荣   常立阳   程灵红   张红梅   

  1. 310007 杭州，1 杭州市中医院血液净化中心
  • 收稿日期:2025-03-11 修回日期:2025-12-02 出版日期:2026-02-12 发布日期:2026-02-02
  • 通讯作者: 张红梅 E-mail: lh85281908@sina.com
  • 基金资助:
    杭州市医药卫生科技重大项目(Z20240017)

Effect of longitudinal changes in modified creatinine index on prognosis among patients undergoing hemodialysis

TIAN Rong-rong, CHANG Li-yang, CHENG Ling-hong, ZHANG Hong-mei   

  1. Department of Blood Purification Centre, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, China
  • Received:2025-03-11 Revised:2025-12-02 Online:2026-02-12 Published:2026-02-02
  • Contact: 310007 杭州，1杭州市中医院血液净化中心 E-mail: lh85281908@sina.com
  • Supported by:

摘要： 目的 分 析 维 持 性 血 液 透 析(maintenance hemodialysis，MHD)患 者 改 良 肌 酐 指 数(modified creatinine index，mCI)水平与预后的关系，探讨mCI纵向变化趋势对MHD患者全因死亡的影响。 方法 回顾性队列研究。选取2017年3月—6月在杭州市中医院进行血液透析治疗的患者进入队列。根 据1年mCI纵向变化趋势，将患者分为mCI下降组及mCI无下降组。终点结局事件为全因死亡，随访截至 2023年6月30日。采用Kaplan-Meier法和COX比例风险模型分析mCI变化趋势对全因死亡的影响。 结 果 共纳入211例患者。平均年龄(61.17±13.74)岁。mCI下降组91例，无下降组120例。中位随访时间 72(43，75)个 月。Kaplan- Meier 曲 线 分 析 结 果 显 示：mCI 下 降 组 患 者 死 亡 风 险 高 于 mCI 无 下 降 组(Log rank χ2 =5.991，P=0.014)。进一步采用COX比例风险模型对混杂因素进行校正，结果显示mCI变化趋势 是全因死亡的独立影响因素(HR=2.149,95%CI：1.236～3.734，P=0.007)，即使在校正基线mCI后该效应 仍存在。mCI下降组患者发生全因死亡的风险是无下降组的2.149倍。 结论 在MHD患者中，mCI下降可 增加全因死亡风险，应动态追踪其变化趋势并及时干预，改善预后。

关键词: 血液透析, 改良肌酐指数, 预后, 全因死亡

Abstract: Objective To analyze the relationship between the modified creatinine index (mCI) level and prognosis in maintenance hemodialysis (MHD) patients, and to explore the effect of longitudinal changes of mCI on all-cause mortality in MHD patients. Methods The study was a retrospective cohort study. Patients who underwent hemodialysis at Hangzhou Hospital of Traditional Chinese Medicine between March 2017 and June 2017 were enrolled. Base on longitudinal changes in mCI over one year from baseline, patients were divided into an mCI decline group and an mCI non-decline group. The outcome was all-cause mortality, with follow-up ending on June 30, 2023. The Kaplan-Meier method and Cox proportional hazards model were used to analyze the effect of longitudinal changes in mCI on all-cause death. Results A total of 211 patients were included, with an mean age of (61.17±13.74) years. There were 91 patients in the mCI decline group and 120 in the non-decline group. The median follow-up time was 72 (QR: 43, 75) months. Kaplan-Meier curve analysis showed that the risk of death was higher in the mCI decline group than that in the non-decline group (Log rank χ2=5.991, P=0.014). After adjusting for confounding factors using the Cox proportional hazards model, the trend of mCI change remained an independent risk factor for all-cause death, even after adjustment for baseline mCI. The risk of all- cause death in the decline group was 2.149 times that in the non- decline group (95% CI: 1.236～3.734, P=0.007). Conclusions In MHD patients, a decline in mCI is associated with an increased risk of all-cause mortality. The longitudinal trend of mCI should be monitored dynamically, and timely interventions should be  implemented to improve prognosis.

Key words: Renal dialysis, Modified creatinine index, Prognosis, All-cause mortality

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