CAJ | 학술논문

目的：探讨血液透析患者血清尿酸水平与死亡风险的关系。方法选择2008年1月至2013年1月广州军区广州总医院肾内科血液净化中心收治的血液透析患者，根据血清尿酸水平进行3分类分组，主要终点事件是死亡，采用COX回归分析血清尿酸与全因死亡风险的关系。3组间累计的全因死亡风险采用Kaplan-Meier曲线和COX回归分析。结果共982例血液透析患者纳入本研究，平均随访时间为25.3个月，最长随访时间为72.0个月。血清尿酸为223～1176（中位数418） mmol/L。以TertileⅡ（399～440 mmol/L）为参考组，TertileⅢ（441～1124 mmol/L）组患者的全因死亡风险明显升高，校正后的全因死亡风险比为1.46（95％ CI 1.23～1.77，P＜0.001）。Tertile I （238～398 mmol/L）组患者的全因死亡风险与 Tertile Ⅱ组比较差异无统计学意义（P＞0.05）。Kaplan-Meier生存曲线联合COX单变量分析显示，3组不同血清尿酸水平患者的全因死亡率比较差异无统计学意义（P＞0.05），但经校正混杂因素后的多因素分析表明，TertileⅢ组患者的生存率最低（P＝0.003）。结论高尿酸血症可增加维持性血液透析患者的病死率，提高死亡风险。
목적：탐토혈액투석환자혈청뇨산수평여사망풍험적관계。방법선택2008년1월지2013년1월엄주군구엄주총의원신내과혈액정화중심수치적혈액투석환자，근거혈청뇨산수평진행3분류분조，주요종점사건시사망，채용COX회귀분석혈청뇨산여전인사망풍험적관계。3조간루계적전인사망풍험채용Kaplan-Meier곡선화COX회귀분석。결과공982례혈액투석환자납입본연구，평균수방시간위25.3개월，최장수방시간위72.0개월。혈청뇨산위223～1176（중위수418） mmol/L。이TertileⅡ（399～440 mmol/L）위삼고조，TertileⅢ（441～1124 mmol/L）조환자적전인사망풍험명현승고，교정후적전인사망풍험비위1.46（95％ CI 1.23～1.77，P＜0.001）。Tertile I （238～398 mmol/L）조환자적전인사망풍험여 Tertile Ⅱ조비교차이무통계학의의（P＞0.05）。Kaplan-Meier생존곡선연합COX단변량분석현시，3조불동혈청뇨산수평환자적전인사망솔비교차이무통계학의의（P＞0.05），단경교정혼잡인소후적다인소분석표명，TertileⅢ조환자적생존솔최저（P＝0.003）。결론고뇨산혈증가증가유지성혈액투석환자적병사솔，제고사망풍험。
Objective Toexploretheassociationbetweenelevatedserumuricacid(SUA)andmor-talityriskinhemodialysispatients.Methods Atotalof982patientswhounderwenthemodialysisinGeneral Hospital of Guangzhou Military Command of PLA from January 2008 to January 201 3 were recruited in this study and categorized into three groups according to SUA concentration by Tertile analysis. Death was deemed as the end-point event. Cox regression models were used to evaluate the relationship between uric acid tertiles and all-cause mortality. Kaplan-Meier survival analysis and Cox regression models were adopted to assess the cumulativeall-causemortalityamongthreegroups.Results Intotal,982hemodialysispatientshadamean follow-up of 25.3 months and a maximum duration up to 72.0 months. The mean concentration of serum SUA was 41 8 mmol/L (range:223~1 1 76 mmol/L). Regarding Tertile II of SUA as the reference standard (399~440 mmol/L),the patients with Tertile III of SUA (441 ~1 1 24 mmol/L)had a significantly higher mortality with an all-cause mortality ratio of 1.46 after adjustment (95% CI 1.23 ~1.77,P<0.001 ). However,the risk of all-cause and CVD mortality between Tertile I (238~398 mmol/L)and II groups did not significantly differ (P>0.05 ). Kaplan-Meier survival analysis and Cox regression models revealed that no association was found between SUA levels and all-cause mortality in all groups. After adjustment of confounding factors,the survivalrateintheTertileIIIgroupwasthelowest(P=0.003).Conclusion ElevatedlevelsofSUAcould increase the mortality risk of patients undergoing hemodialysis.