维持性血液透析患者血尿酸水平及变异性与死亡的关系

目的探讨维持性血液透析患者血尿酸水平及变异性与死亡发生之间的关系。方法回顾性分析2008年1月至2011年9月在首都医科大学附属北京友谊医院血液透析中心接受维持性血液透析治疗患者的临床资料,统计每个患者血尿酸平均值和变异性,根据死亡患者血尿酸平均值的平均值及变异性平均值将患者为高尿酸高变异组(1组)、高尿酸低变异组(2组)、低尿酸高变异组(3组)、低尿酸低变异组(4组),计算各组病死率,并作两两比较,进一步对上述四组进行合并后再分析,按死亡组患者血尿酸平均值的平均值(364.08 mmol/L)作为界值,将所有患者分为高尿酸组(A组)和低尿酸组(B组),统计两组病死率并作比较,按死亡组患者血尿酸变异性(50.89 mmol/L)将所有患者分为:高变异性组(C组)和低变异性组(D组)统计两组病死率并做比较,将血尿酸与透前血肌酐、尿素、胆固醇、白蛋白水平做线性回归分析。结果①死亡组血尿酸平均值、白蛋白的平均值、肌酐的平均值、尿素的平均值、血红蛋白的平均值均低于存活组(P<0.05),而年龄和血尿酸变异性均高于存活组(P<0.05)。②年龄和尿酸变异性是发生MHD患者死亡的独立危险因素,肌酐、血红蛋白则不是MHD患者死亡发生的独立危险因素。③无论平均值大小,尿酸变异性大的患者病死率高于死变异性小的患者(P<0.001)。当变异性≥50.89 mmol/L时,尿酸平均值小的患者病死率高于尿酸平均值大的患者(P=0.099);当变异性<50.89 mmol/L时,尿酸平均值小的患者病死率高于尿酸平均值大的患(P<0.003)。④尿酸与营养指标(尿素、肌酐)呈正的直线相关。结论维持型血液透析患者变异性大(≥50.89mmol/L)时,尿酸平均值对病死率无影响。尿酸变异性小(<50.89 mmol/L)时,尿酸平均值小的病死率高。尿酸可能是反应营养状态指标之一,受其他营养指标影响。

The relationship between the level and variability of serum uric acid and mortality in hemodialysis patients

Objective To investigate the relationship between the level and variability of serum uric acid and mortality in hemodialysis patients. Methods Means of serum uric acid level and its variability of patients who underwent hemodialysis in our hospital from January 2008 to September 2011 were retrospectively analyzed. According to the mean of serum uric acid （364.08 mmoL/L） and mean of variability （50. 89 mmol/L） in dead patients, the patients were divided into group Ⅰ （high uric acid and high variability）, group Ⅱ （high uric acid and low varia- bility） , groupⅢ（low uric acid and high variability） and group Ⅳ （low uric acid and low variability）. In addition, the patients were further grouped into group A （high uric acid）, group B （low uric acid）, group C （high variability） and group D （low variability）. The mortality in each group was analyzed and pairwise comparison was made. Linear regression analysis was performed and variables used for analysis included serum u- ric acid, creatinine, urea, cholesterol, and albumin. Results 1. The means of serum uric acid, albumin, creatinine, urea, and hemoglobin were all lower （ P 〈0. 05 ）, but age and variability of serum uric acid were higher （ P 〈0. 05 ） in group of dead patients than those in group of survivors. 2. Age and uric acid variability were, but creatinine and hemoglobin were not independent risk factors for death occurred in maintenance hemodialysis patients. 3. The mortality was higher in patients with high variability of uric acid than that in patients with low variability of uric acid （ P 〈0. 001 ）. When the variability was greater than or equal to 50.89 retool/L, the mean value of uric acid did not related to the mortality of the patients （ P =0. 099） ;however, when the variability was less than 50.89 mol/L, the mortality was higher in patients with small mean of uric acid than that in patients with greater mean of uric acid （ P 〈0. 003 ）. 4. Uric acid and nutrition indicators （ urea, creatinine） presented a posi- tive linear correlation. Conclusion When the variability of serum uric acid was greater than or equal to 50.89 mmol/L, the mean value of uric acid does not show effect on mortality of the patients with maintainance hemodialysis; when the variability was less than 50.89 mmol/L, the mortality is high in patients with small mean of uric acid. Uric acid may be one of the indicators of nutritional status and it is influenced by other nutritional factors.