前白蛋白与维持性血液透析患者死亡的关系

目的探讨前白蛋白与维持性血液透析(MHD)患者死亡的关系。 方法回顾分析了2012年1月至2018年6月北京民航总医院行维持性血液透析(透析龄≥3月)的患者的一般情况、生化指标以及预后；以死亡患者为研究组，存活患者为对照组；以t检验、非参数检验、χ²检验将两组患者数据进行比较，并使用Logistic回归分析的方法分析与MHD患者全因死亡相关的危险因素。 结果①纳入研究患者325例，平均年龄(63.4±13.4)岁，透析龄64.0(41.5±98.5)月，存活组210例、死亡组115例，死亡原因主要包括感染(24%)、心血管疾病(17%)、脑血管疾病(16%)、恶液质(12%)、肿瘤(10%)等。②死亡组白蛋白、前白蛋白、血肌酐、尿素氮、血磷、全段甲状旁腺激素均明显低于存活组(P<0.05)；CRP(Z＝－5.824)、透析龄(Z＝－2.827)及年龄(t＝7.672)明显高于存活组(P<0.05)。男性与女性的死亡率无明显差别(χ²＝0.274，P>0.05)，糖尿病组与非糖尿病组死亡率具有明显差异(χ²＝7.230，P<0.05)。③多因素Logistic回归分析显示年龄、透析龄、是否合并糖尿病、白蛋白、前白蛋白与MHD患者死亡独立相关；白蛋白(OR＝0.854)及前白蛋白(OR＝0.983)是独立保护因素(P<0.05)；增龄(OR＝1.046)、透析龄延长(OR＝1.012)、合并糖尿病(OR＝2.201)是独立危险因素(P<0.05)。④前白蛋白与白蛋白正相关(r＝0.609，P<0.001)，前白蛋白与其他营养指标相关性比白蛋白强。 结论前白蛋白与白蛋白对MHD患者的死亡具有独立保护作用，在预测MHD患者死亡时至关重要。

Relationship between prealbumin and mortality in maintenance hemodialysis patients

ObjectiveTo investigate the relationship between prealbumin and mortality in patients undergoing maintenance hemodialysis (MHD). MethodsRetrospective analysis of general conditions, biochemical indicators, and prognosis of patients undergoing MHD (dialysis age ≥3 months) in Beijing Civil Aviation General Hospital from January 2012 to June 2018. The data of dead patients were taken as the dead group, while data of the survivors were received as the survivor group. The data of the two groups were compared with t test, nonparametric test, and χ² test. Logistic regression analysis method was used to analyze the risk factors associated with all-cause death in MHD patients. Results① 325 MHD patients were included in the study, whose mean age was 63.4±13.4 years, dialysis age was 64.0(41.5, 98.5)months. The survival group had 210 cases, and the death group had 115 cases. The primary causes of the death included infection (24%), cardiovascular diseases (17%), cerebrovascular diseases (16%), cachexia (12%), and tumors (10%), etc. ② The levels of albumin, prealbumin, serum creatinine, urea nitrogen, blood phosphorus, and intact parathyroid hormone of the dead group were all significantly lower than those in the survivor group (P<0.05). However, CRP (Z=5.824), dialysis age (Z=2.827), and patient age (t=7.672)were significantly higher than those of survivor group (P<0.05). There was no significant difference in the mortality between male and female (χ²=0.274, P>0.05), while the difference of mortality between diabetes patients and non-diabetes patients was significant (χ²=7.230, P<0.05). ③ Logistic regression analysis showed that patient age, dialysis age, diabetes, albumin, and prealbumin were independently associated with death in the MHD patients. Albumin (OR=0.854) and prealbumin (OR=0.983) were independent protective factors (P<0.05), while the patient age (OR=1.046), dialysis age (OR=1.012), and diabetes (OR=2.201)were independent risk factors (P<0.05). ④Prealbumin was positively associated with albumin (r=0.609, P<0.001), but prealbumin was positively associated with other nutritional indexes to a greater degree. ConclusionPrealbumin and albumin had independent protective effects on the motality of the MHD patients, which were crucial in predicting the death in the MHD patients.