维持性血液透析患者25(OH)维生素D水平与病死率相关性分析

目的：分析维持性血液透析（MHD）患者25（OH）维生素D[25（OH）D]水平与病死率的关系。方法收集2010年7月该院血液净化中心MHD患者156例，检测患者血25（OH）D水平，根据患者血25（OH）D水平分为3组，分别为缺乏组49例、不足组69例和正常组38例。随访时间为40个月，终点事件为全因死亡和心血管疾病死亡。结果随访40个月后，156例中死亡26例（16．7％），因心血管疾病死亡13例。缺乏组死亡15例（30．6％），其中心血管疾病死亡9例；不足组死亡8例（11．6％），其中心血管疾病死亡3例；正常组死亡3例（7．9％），其中心血管疾病死亡1例。缺乏组全因病死率及心血管疾病病死率分别与不足组和正常组比较，差异均有统计学意义（P＜0．05）。Kaplan‐Meier曲线分析显示，25（OH）D≤15 ng／mL是全因和心血管疾病病死率的危险因素（P＜0．05）。Cox回归分析未矫正（RR＝4．43，95％ CI：1．28～15．32，P＜0．05）和矫正（RR＝4．92，95％ CI：1．23～19．66，P＜0．05）年龄、性别等因素后结果均显示25（O H ）D≤15 ng／m L是全因病死率的危险因素，未矫正时25（O H ）D≤15 ng／mL是心血管疾病死亡率的危险因素（RR＝8．12，95％ CI：1．04～64．15，P＝0．047）。结论 MHD患者25（OH）D水平普遍偏低，25（OH）D≤15 ng／mL为MHD患者全因和心血管疾病病死率的危险因素。

Low level of 25 (OH)D predict mortality in maintenance hemodialysis patients

Objective To analyze the relationship between the level of 25 (OH )D and mortality in maintenance hemodialysis (M HD) patients .Methods This study was a prospective cohort study .We enrolled 156 M HD patients of Sichuan people′s hospital dialysis center in July of 2010 .The patients were divided into three groups according to the level of 25(OH)D .The three groups were normal(25(OH)D>30 ng/mL) ,insufficient(15 ng/mL<25(OH)D≤30 ng/mL) and deficient(25(OH)D≤15 ng/mL) re‐spectively .All the patients were follow‐up 40 months ;the end point was all‐cause and cardiovascular death .Results After follow‐up 40 months ,there were 26 deaths (16 .7% ) and 13 cardiovascular deaths among the 156 cases .There were 15 deaths (30 .6% ) in in‐sufficient group ,among which there were nine cardiovascular deaths ;there were eight deaths (11 .6% ) in deficient group ,among which there were three cardiovascular deaths ;there were three deaths (7 .9% ) in normal group ,among which there was one cardio‐vascular death .There was statistically significance either between all‐cause and cardiovascular mortality of deficient and normal group or between deficient and insufficient group (P<0 .05) .The Kaplan‐Meier curve analysis showed 25(OH)D≤15 ng/mL was the independent risk factor of the all‐cause and cardiovascular mortality(P<0 .05) .Cox regression showed 25(OH)D≤15 ng/mL was the independent risk factor of the all‐cause mortality in crude analysis (RR=4 .43 ,95% CI:1 .28-15 .32 ,P<0 .05) and adjus‐ted analysis (RR=4 .92 ,95% CI 1 .23-19 .66 ,P<0 .05) .Cox regression showed 25(OH)D≤15 ng/mL was the risk factor of the cardiovascular mortality in crude analysis(RR=8 .12 ,95% CI:1 .04 -64 .15 ,P=0 .047) .Conclusion 25(OH)D≤15 ng/mL was the risk factor and predictor of the all‐cause and cardiovascular mortality in M HD patients .