血浆白蛋白波动与维持性血液透析患者不良事件的相关分析

目的回顾性分析我科透析中心维持性血液透析患者血浆白蛋白（albumin，Alb）及波动与患者不良事件发生的关系。方法纳入符合条件的129例血液透析患者，以住院或死亡定义为不良事件。以该研究人群的平均血浆白蛋白（meanserul serumin，Albmean）水平为标准，计算患者单次血浆白蛋白水平相对Albmean的变化值即波动。以标准差SDAIbmean=√∑（xi—Albmean）。／N-1表示。使用卡方检验，Kaplan-Meier法及COX比例风险回归进行统计分析。结果（1）Alb—mean≤40g／L组不良事件发生率明显高于〉40g／L组（P：0．037）。（2）SDA1bmean≤3．0g／L组不良事件发生率明显低于〉3．0g／L组（P=0．01）。（3）将患者分为4组，Alb≤40g／L＋SDAlbmean〉3．0g／L组不良事件发生率明显高于其他3组（P=0．008）。与Alb〉40g／L＋SDAlbmean≤3．0g／L组比较，Alb≤40g／L＋SDAlbmean〉3．0g／L组患者有3．2倍高的不良事件发生风险。结论Albmean及SDAlbmean与维持性血液透析患者不良事件发生相关。当血液透析患者Albmean〉40g／L及SDAIbmean≤3．0g／L时可能有利于减少不良事件发生。

Correlation analysis of serum albumin fluctuation and the adverse events of maintenance hemodiulysis patients

Objective To retrospectively analyze serum albumin levels and fluctuations in maintenance hemodialysis patients, and their correlation with adverse events. Methods 129 patients were included in our study. Hospitalization and/or deaths were defined as adverse events. The mean serum albumin of all patients served as a standard to measure the level fluctuation of serum albumin. SDAlb- mean= √∑（xi-Albmean）2/N- 1 was used to calculate the fluctuation of serum albumin. Chi-square test,Kaplan-Meier and Cox proportional hazard regressions were used to determine the correlation of the average serum albumin level and its fluctuation with the adverse events. Results （1） The adverse events rate in the mean serum albumin440 g/L group was significantly higher than in〉40 g/L group （P = 0. 037） ; （2）The adverse events rate in the SDAlbmean 〉3.0 g/L group was significantly higher than in the 43. 0 g/L group（P = 0. 01） ; （3）Patients were divided into four groups. The incidence in the Alb≤40 g/L ＋ SDAlbmean 〉3.0 g/L group was significantly higher than that in the other three groups （P= 0. 008）. The risk of adverse events in the Alb440 g/L ＋ SDAlbmean 〉3. 0 g/L group was 3. 2 times higher than in the Alb〉40 g/L ＋ SDAlbmean 43. 0 g/L group. Conclusions Serum albumin and its fluctuation are associated with the adverse events of maintenance hemodialysis patients. Serum albumin 〉40 g/L, and SDAlbmean 43. 0 g/L may be help to reduce the incidence of adverse events of maintenance hemodialysis patients.