维持性血液透析患者血清铁蛋白水平与预后的关系
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摘要
目的探讨维持性血液透析患者血清铁蛋白(SF)水平与预后的关系。方法选取2011年6月至2012年12月在简阳市人民医院肾内科行维持性血液透析的终末期肾病(ESRD)患者180例为研究对象。患者随诊终止时间为2017年12月31日,记录透析相关指标及结局事件指标,主要终点事件为死亡。采用非参数分析乘积估计法(Kaplan-Meier)计算累积生存率。采用单因素及多因素COX比例风险模型分析影响维持性血液透析患者预后的独立危险因素。结果高SF组与低SF组1年、2年、3年、5年的累积生存率分别为78.57%、69.05%、57.14%、42.86%与89.86%、82.61%、73.91%、60.15%。经Log-rank检验两组生存率比较差异有统计学意义(P<0.05);经多因素COX回归分析模型显示,高SF水平是维持性血液透析患者死亡的独立危险因素(P<0.05);高SF组心血管疾病、感染死亡比例高于低SF组(P<0.05)。结论高SF水平的血液透析患者生存率较低,高SF水平是维持性血液透析患者死亡的独立危险因素。
Objective To explore the relationship of serum ferritin(SF) level with prognosis in maintenance hemodialysis patients.Methods From June 2011 to December 2012, 180 patients with end-stage renal diseases(ESRD) who underwent maintenance hemodialysis in the Department of Nephrology of Jianyang People's Hospital were selected as the subjects. These patients were followed up until December 31, 2017. Dialysis related indicators and outcome indicators were recorded. The main endpoint event was death. Cumulative survival rate was calculated with a non-parametric product estimation method, the Kaplan-Meier method. Single-variate and multivariate COX proportional hazard models were adopted to analyze the independent hazard factors influencing prognosis of maintenance hemodialysis patients. Results The one-year, two-year, three-year and five-year cumulative survival rates of the high SF group and low SF group were 78.57%, 69.05%, 57.14%, 42.86% and 89.86%, 82.61%, 73.91% and 60.15%, respectively. There was a significant difference in survival rate between the two groups by Log-rank test showed difference of statistical significance in the survival rate between two groups(P<0.05). Multivariate COX regression analysis indicated that high SF level was an independent hazard factor for mortality in maintenance hemodialysis patients(P<0.05). The mortality rates of cardiovascular disease and infection in the high SF group was higher than that those in the low SF group(P<0.05). Conclusions The survival rate of hemodialysis patients with high SF level is relatively low. High SF level is an independent hazard factor for mortality in maintenance hemodialysis patients.
Objective To explore the relationship of serum ferritin(SF) level with prognosis in maintenance hemodialysis patients.Methods From June 2011 to December 2012, 180 patients with end-stage renal diseases(ESRD) who underwent maintenance hemodialysis in the Department of Nephrology of Jianyang People's Hospital were selected as the subjects. These patients were followed up until December 31, 2017. Dialysis related indicators and outcome indicators were recorded. The main endpoint event was death. Cumulative survival rate was calculated with a non-parametric product estimation method, the Kaplan-Meier method. Single-variate and multivariate COX proportional hazard models were adopted to analyze the independent hazard factors influencing prognosis of maintenance hemodialysis patients. Results The one-year, two-year, three-year and five-year cumulative survival rates of the high SF group and low SF group were 78.57%, 69.05%, 57.14%, 42.86% and 89.86%, 82.61%, 73.91% and 60.15%, respectively. There was a significant difference in survival rate between the two groups by Log-rank test showed difference of statistical significance in the survival rate between two groups(P<0.05). Multivariate COX regression analysis indicated that high SF level was an independent hazard factor for mortality in maintenance hemodialysis patients(P<0.05). The mortality rates of cardiovascular disease and infection in the high SF group was higher than that those in the low SF group(P<0.05). Conclusions The survival rate of hemodialysis patients with high SF level is relatively low. High SF level is an independent hazard factor for mortality in maintenance hemodialysis patients.
引文
[1] 张改华,饶向荣.急性肾损伤:慢性肾脏病进展至终末期肾病的跳板[J].中国中西医结合肾病杂志,2013,14(9):830-832.
[2] Hoerger TJ,Burrows NR,Pavkov ME,et al.The future burden of CKD in the United States:a simulation model for the CDC CKD Initiative[J].Am J Kidney Dis,2015,65(3):403-411.
[3] Kjaergaard KD,Rehling M,Jensen JD,et al.Reliability of endogenous markers for estimation of residual renal function in haemodialysis patients[J].Clin Physiol Funct Imaging,2013,33(3):224-232.
[4] Gilg J,Rao A,Williams AJ.UK renal registry 18th annual report:chapter 8 haemoglobin,ferritin and erythropoietin amongst uk adult dialysis patients in 2014:national and centre- specific analyses[J].Nephron,2016,132(Suppl 1):169-194.
[5] Latus J,Maruyama Y,Yokoyama K,et al.The different association between serum ferritin and mortality in hemodialysis and peritoneal dialysis patients using Japanese nationwide dialysis registry[J].PLoS One,2015,10(11):e0143430.
[6] 中国中西医结合学会肾脏疾病专业委员会.慢性肾衰竭中西医结合诊疗指南[J].中国中西医结合杂志,2015,35(9):1029-1033.
[7] 张超,胡昭,董帅.终末期肾病维持性血液透析患者生存率和死亡的影响因素[J].中国老年病学杂志,2014,10(12):1241-1243.
[8] 钟小仕,谭荣韶,覃丹平,等.血清白蛋白水平与血液透析患者预后的关系[J].广东医学,2013,34(16):2516-2518.
[9] 周康康,张均玉,周红卫.终末期肾病患者死亡原因及危险因素分析[J].临床肾脏病杂志,2018,18(4):224-228.
[10] 李静,王利华,程丽娟,等.2010-2012年山西省血液透析死亡患者流行病学调查[J].中华肾脏病杂志,2014,30(2):123-127.
[11] 马云华,潘玲,廖蕴华.腹膜透析患者血清铁蛋白水平与微炎症及透析效果相关性分析[J].中华肾病研究电子杂志,2016,5(2):65-69.
[12] Pourmoghaddas A,Sanei H,Garakyaraghi M,et al.The relation between body iron store and ferritin,and coronary artery disease[J].ARYA Atheroscler,2014,10(1):32-36.
[13] Klip IT,Voors AA,Swinkels DW,et al.Serum ferritin and risk for new-onset heart failure and cardiovascular events in the community[J].Eur J Heart Fail,2017,19(3):348-356.
[14] Kuragano T,Matsumura O,Matsuda A,et al.Association between hemoglobin variability,serum ferritin levels,and adverse events/mortality in maintenance hemodialysis patients[J].Kidney Int,2014,86(4):845-854.
[15] Grammer TB,Kleber ME,Silbernagel G,et al.Hemoglobin,iron metabolism and angiographic coronary artery disease (The Ludwigshafen Risk and Cardiovascular Health Study)[J].Atherosclerosis,2014,236(2):292-300.
[16] Ishida JH,Johansen KL.Iron and infection in hemodialysis patients[J].Semin Dial,2014,27(1):26-36.
[17] Kao JK,Wang SC,Ho LW,et al.Chronic iron overload results in impaired bacterial killing of thp-1 derived macrophage through the inhibition of lysosomal acidification[J].PLoS One,2016,11(5):e0156713.
[18] Kato S,Lindholm B,Yuzawa Y,et al.High ferritin level and malnutrition predict high risk of infection-related hospitalization in incident dialysis patients:a Japanese prospective cohort study[J].Blood Purif,2016,42(1):56-63.
[19] 车伟伟,赵德龙.维持性血液透析患者血清铁蛋白与血红蛋白及其达标率关系探讨[J].中国血液净化,2017,16(10):672-675.
[20] Pourmoghaddas A,Sanei H,Garakyaraghi M,et al.The relation between body iron store and ferritin and coronary artery disease[J].ARYA Atheroscler,2014,10(1):32-36.
[21] 林丽容,黄明生,林石生.慢性肾病患者血肌酐含量检测及其与心功能损害的关系[J].海南医学院学报,2015,21(1):61-62.
[22] Supiano KP,Luptak M.Complicated grief in older adults:a randomized controlled trial of complicated grief group therapy[J].Gerontologist,2014,54(5):840-856.
[23] 俞雨生.腹膜透析患者纠正钙磷代谢紊乱应注意的问题[J].肾脏病与透析肾移植杂志,2013,22(6):545-546.
[2] Hoerger TJ,Burrows NR,Pavkov ME,et al.The future burden of CKD in the United States:a simulation model for the CDC CKD Initiative[J].Am J Kidney Dis,2015,65(3):403-411.
[3] Kjaergaard KD,Rehling M,Jensen JD,et al.Reliability of endogenous markers for estimation of residual renal function in haemodialysis patients[J].Clin Physiol Funct Imaging,2013,33(3):224-232.
[4] Gilg J,Rao A,Williams AJ.UK renal registry 18th annual report:chapter 8 haemoglobin,ferritin and erythropoietin amongst uk adult dialysis patients in 2014:national and centre- specific analyses[J].Nephron,2016,132(Suppl 1):169-194.
[5] Latus J,Maruyama Y,Yokoyama K,et al.The different association between serum ferritin and mortality in hemodialysis and peritoneal dialysis patients using Japanese nationwide dialysis registry[J].PLoS One,2015,10(11):e0143430.
[6] 中国中西医结合学会肾脏疾病专业委员会.慢性肾衰竭中西医结合诊疗指南[J].中国中西医结合杂志,2015,35(9):1029-1033.
[7] 张超,胡昭,董帅.终末期肾病维持性血液透析患者生存率和死亡的影响因素[J].中国老年病学杂志,2014,10(12):1241-1243.
[8] 钟小仕,谭荣韶,覃丹平,等.血清白蛋白水平与血液透析患者预后的关系[J].广东医学,2013,34(16):2516-2518.
[9] 周康康,张均玉,周红卫.终末期肾病患者死亡原因及危险因素分析[J].临床肾脏病杂志,2018,18(4):224-228.
[10] 李静,王利华,程丽娟,等.2010-2012年山西省血液透析死亡患者流行病学调查[J].中华肾脏病杂志,2014,30(2):123-127.
[11] 马云华,潘玲,廖蕴华.腹膜透析患者血清铁蛋白水平与微炎症及透析效果相关性分析[J].中华肾病研究电子杂志,2016,5(2):65-69.
[12] Pourmoghaddas A,Sanei H,Garakyaraghi M,et al.The relation between body iron store and ferritin,and coronary artery disease[J].ARYA Atheroscler,2014,10(1):32-36.
[13] Klip IT,Voors AA,Swinkels DW,et al.Serum ferritin and risk for new-onset heart failure and cardiovascular events in the community[J].Eur J Heart Fail,2017,19(3):348-356.
[14] Kuragano T,Matsumura O,Matsuda A,et al.Association between hemoglobin variability,serum ferritin levels,and adverse events/mortality in maintenance hemodialysis patients[J].Kidney Int,2014,86(4):845-854.
[15] Grammer TB,Kleber ME,Silbernagel G,et al.Hemoglobin,iron metabolism and angiographic coronary artery disease (The Ludwigshafen Risk and Cardiovascular Health Study)[J].Atherosclerosis,2014,236(2):292-300.
[16] Ishida JH,Johansen KL.Iron and infection in hemodialysis patients[J].Semin Dial,2014,27(1):26-36.
[17] Kao JK,Wang SC,Ho LW,et al.Chronic iron overload results in impaired bacterial killing of thp-1 derived macrophage through the inhibition of lysosomal acidification[J].PLoS One,2016,11(5):e0156713.
[18] Kato S,Lindholm B,Yuzawa Y,et al.High ferritin level and malnutrition predict high risk of infection-related hospitalization in incident dialysis patients:a Japanese prospective cohort study[J].Blood Purif,2016,42(1):56-63.
[19] 车伟伟,赵德龙.维持性血液透析患者血清铁蛋白与血红蛋白及其达标率关系探讨[J].中国血液净化,2017,16(10):672-675.
[20] Pourmoghaddas A,Sanei H,Garakyaraghi M,et al.The relation between body iron store and ferritin and coronary artery disease[J].ARYA Atheroscler,2014,10(1):32-36.
[21] 林丽容,黄明生,林石生.慢性肾病患者血肌酐含量检测及其与心功能损害的关系[J].海南医学院学报,2015,21(1):61-62.
[22] Supiano KP,Luptak M.Complicated grief in older adults:a randomized controlled trial of complicated grief group therapy[J].Gerontologist,2014,54(5):840-856.
[23] 俞雨生.腹膜透析患者纠正钙磷代谢紊乱应注意的问题[J].肾脏病与透析肾移植杂志,2013,22(6):545-546.