CAJ | 학술논문

目的：探讨老年血液透析患者脂联素水平与主要不良心脑血管事件（MACCE）及生存率的相关性。方法选择79例老年血液透析患者，检测脂联素水平，以正常值下线5 m g/L为界，≥5 m g/L为高脂联素组44例，＜5 mg/L为低脂联素组35例。记录随后3年患者的死亡时间及原因；用Kaplan-Meier方法分析无MACCE生存率；Cox回归分析脂联素及其他因素对患者长期预后的影响。结果随访期间，低脂联素组共发生M ACCE 25例次，6、12、24和36个月无M ACCE生存率分别为77．1％、65．7％、42．9％和28．6％，脂联素有逐渐下降趋势，24、36个月下降更明显（P＜0．01）；高脂联素组共发生MACCE 18例次，无MACCE生存率分别为88.6％、72．7％、59．1％和38.6％。生存分析显示，2组生存率比较，差异有统计学意义（P＜0．01），Cox单因素分析，脂联素是影响患者远期预后的独立危险因素（P＜0．05）。结论随访过程中，低脂联素组伴随脂联素水平的降低，MACCE逐渐增多。脂联素可作为老年血液透析患者M ACCE的良好预测指标，并与远期生存率相关，有较好的临床应用价值。
목적：탐토노년혈액투석환자지련소수평여주요불양심뇌혈관사건（MACCE）급생존솔적상관성。방법선택79례노년혈액투석환자，검측지련소수평，이정상치하선5 m g/L위계，≥5 m g/L위고지련소조44례，＜5 mg/L위저지련소조35례。기록수후3년환자적사망시간급원인；용Kaplan-Meier방법분석무MACCE생존솔；Cox회귀분석지련소급기타인소대환자장기예후적영향。결과수방기간，저지련소조공발생M ACCE 25례차，6、12、24화36개월무M ACCE생존솔분별위77．1％、65．7％、42．9％화28．6％，지련소유축점하강추세，24、36개월하강경명현（P＜0．01）；고지련소조공발생MACCE 18례차，무MACCE생존솔분별위88.6％、72．7％、59．1％화38.6％。생존분석현시，2조생존솔비교，차이유통계학의의（P＜0．01），Cox단인소분석，지련소시영향환자원기예후적독립위험인소（P＜0．05）。결론수방과정중，저지련소조반수지련소수평적강저，MACCE축점증다。지련소가작위노년혈액투석환자M ACCE적량호예측지표，병여원기생존솔상관，유교호적림상응용개치。
Objective To study the association of serum adiponectin (APN) level with MACCE andsurvival rate in elderly patients on hemodialysis .Methods Seventy-nine elderly patients on hemodialysiswere enrolled in this study .Their APN level was measured .The patients were divided intoAPN ≥ 5 mg/L group (n= 44) and APN < 5 mg/L group (n = 35) .The patients were followed upfor 3 years during which the time and reasons of death were recorded .Their MACCE-free survivalrate was analyzed with the Kaplan-Meier method .The effect of APN level and other factors ontheir long-term outcome was analyzed by Cox regression analysis .Results MACCE occurred 25times/cases in APN < 5 mg/L group during the follow-up .The MACCE-free survival rate was77. 1% ,65 .7% ,42 .9% and 28 .6% for 6 ,12 ,24 and 36 months ,respectively .The ANP level decreasedgradually ,especially in 24 and 36 months ( P < 0 .01) .MACCE occurred 18 times/cases inANP ≥ 5 mg/L group during the follow-up .Their MACCE-free survival rate was 88 .6% ,72 .7% ,59 .1% and 38 .6% was for 6 ,12 ,24 and 36 months ,respectively .No significant change was foundin their APN level(P > 0 .05) .Survival analysis showed that the survival rate was different in twogroups ( P < 0 .01) .Cox univariate analysis showed that ANP level was an independent risk factorfor the long-term outcome in elderly patients ( P < 0 .05) .Conclusion The incidence of MACCEincreases with the decreasing APN level in those with their APN < 5 mg/L .APN level can be usedas a predictor for MACCE and long-term survival rate in elderly patients on hemodialysis .