上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

维持性血液透析患者营养不良-炎症复合体综合征与预后的关系研究

段绍霞1，2，蔡宏1,2，张伟明1,2，朱铭力2，陆任华2，鲁嘉越1,2，蒋蓉1,2，章海芬2，倪兆慧1，2，钱家麒2   

  1. 上海交通大学  医学院 1.附属仁济医院南院肾脏科， 上海 201112； 2.附属仁济医院肾脏科， 上海 200127
  • 出版日期:2015-12-28 发布日期:2016-01-21
  • 通讯作者: 张伟明, 电子信箱: weimingzh1965@163.com。
  • 作者简介:段绍霞（1989—）， 女， 硕士生 ; 电子信箱: dsxiii@126.com。
  • 基金资助:

    上海交通大学医学院附属仁济医院南院临床学科创新共建平台建设项目（2014MDT02）

Correlation between malnutrition-inflammation complex syndrome and prognosis of patients undergoing maintenance hemodialysis

DUAN Shao-xi1,2, CAI Hong1,2, ZHANG Wei-ming1,2, ZHU Ming-li2, LU Ren-hua2, LU Jia-yue1,2, JIANG Rong1,2, ZHANG Hai-fen2, NI Zhao-hui1,2, QIAN Jia-qi2   

  1. 1.Department of Nephrology， Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai 201112， China； 2.Department of Nephrology, Renji Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200127， China
  • Online:2015-12-28 Published:2016-01-21
  • Supported by:

    Construction of Clinical Discipline Innovation Platform of Renji Hospital South Campus of Shanghai Jiao Tong University School of Medicine, 2014MDT02

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摘要：

目的  通过对维持性血液透析（MHD）患者营养和炎症相关指标的回顾性分析，探讨营养不良-炎症复合体综合征（MICS）与MHD患者预后的关系。方法  入选2007年1月1日—2014年12月31日在上海交通大学医学院附属仁济医院血透中心接受MHD治疗≥3个月的患者527例，分为MICS组和非MICS组。采用logistic回归分析MHD患者并发MICS的危险因素，Kaplan-Meier分析MHD患者生存率，Cox比例风险模型分析MICS患者全因死亡和心血管疾病死亡的危险因素。结果  527例患者中MICS患者441例（83.63%），MICS组患者年龄较大、BMI较高、透析龄较长、血红蛋白较低。多因素logistic回归显示年龄增长、透析龄增加、血红蛋白<100 g/L是MHD患者并发MICS的独立危险因素。Kaplan-Meier分析显示MICS患者全因病死率（Log-Rank检验，P=0.040）及心血管疾病病死率（Log-Rank检验，P=0.038）明显高于非MICS患者。Cox回归显示年龄增长、透析龄增加、血红蛋白低、总胆固醇降低、低密度脂蛋白升高是预测MICS患者全因死亡及心血管疾病死亡的独立危险因素。结论  MHD患者MICS患病率高；并发MICS预后较非MICS差；贫血与MICS的发生及预后密切相关。

关键词: 营养不良-炎症复合体综合征, 维持性血液透析, 生存率, 贫血

Abstract:

Objective  To explore the correlation between malnutrition-inflammation complex syndrome (MICS) and the prognosis of patients who undergo maintenance hemodialysis (MHD) by retrospective analysis of relevant indexes of malnutrition and inflammation. Methods  A total of 527 patients who underwent MHD for more than 3 months at the Hemodialysis Center of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2007 to December 31, 2014 were enrolled and divided into MICS group and non-MICS group. Logistic regression analysis was adopted to analyze risk factors of the incidence of MICS of patients who underwent MHD. The survival rate of patients was analyzed by Kaplan-Meier method. Risk factors of all-cause death and death of cardiovascular diseases of patients with MICS were analyzed by the Cox proportional hazards models. Results  Among 527 patients, there were 441 patients (83.63%) with MICS. Patients of MICS group were older with higher body mass index, longer time of dialysis, and lower level of hemoglobin. Multivariate logistic regression analysis showed that older age, longer time of dialysis, and hemoglobin level less than 100 g/L were independent risk factors of the incidence of MICS of patients who underwent MHD. Kaplan-Meier analysis indicated that all-cause mortality (Log-Rank test, P=0.040) and cardiovascular disease (CVD) mortality (Log-Rank test, P=0.038) of patients with MICS were significantly higher than those of patients without MICS. Cox regression analysis showed that older age, longer time of dialysis, lower levels of hemoglobin and total cholesterol, and higher level of low density lipoprotein were independent risk factors of predicting all-cause death and death of cardiovascular diseases of patients with MICS. Conclusion  The incidence of MICS of patients who undergo MHD is high. The prognosis of patients with MICS is poorer than that of patients without MICS. Anemia is closely correlated with the incidence and prognosis of MICS.

Key words: malnutrition-inflammation complex syndrome, maintenance hemodialysis, survival rate； anemia