CAJ | 학술논문

目的探讨维持性血液透析(MHD)患者长期预后的影响因素及血清肌钙蛋白T(cTnT)和C反应蛋白(CRP)的意义.方法回顾性分析2002年1月至2003年1月期间本院76例MHD患者的临床资料,记录随后10年间死亡患者的死亡时间及原因；用Kaplan-Meier计算生存率；Cox回归分析cTnT、CRP及其他因素对患者长期预后的影响.结果 76例患者中CRP阳性28例(36.8％),cTnT阳性22例(28.9％)；中位生存时间为37.9个月；2年生存率为65.9％,10年生存率为24.2％.单因素分析结果显示,CRP阳性、cTnT阳性、老年、糖尿病、心脑血管疾病、贫血、低血清白蛋白(Alb)、Kt/V下降与长期预后相关.多因素分析结果显示,年龄增加(P=0.010)、心脑血管疾病(P=0.048)、cTnT阳性(P=0.036)、CRP阳性(P=0.009)是影响透析患者10年生存率的独立危险因素.cTnT阳性组患者10年心脑血管疾病病死率与阴性组差异无统计学意义(50.0％比35.4％,P=0.248),但2年心脑血管疾病病死率显著高于阴性组(40.9％比14.6％,P=0.015).CRP阳性组患者2年及10年心脑血管疾病病死率均高于阴性组(48.1％比7.0％,P=0.000；66.7％比23.3％,P=0.000).与血清cTnT及CRP双阴性组患者相比,双阳性组全因死亡率(92.9％比55.6％,P=0.030)、心脑血管疾病病死率(64.3％比25.0％,P=0.009)及2年内心脑血管疾病病死率(57.1％比5.6％,P=0.000)均较高.结论老龄、心脑血管疾病、cTnT阳性及CRP阳性是影响MHD患者长期预后的独立危险因素.cTnT阳性可以预测MHD患者2年内的心脑血管疾病死亡,而CRP阳性则同时可预测近期及远期心脑血管疾病死亡.cTnT与CRP双阳性对于预测MHD患者近期及远期预后不良更有意义.
목적 탐토유지성혈액투석(MHD)환자장기예후적영향인소급혈청기개단백T(cTnT)화C반응단백(CRP)적의의.방법 회고성분석2002년1월지2003년1월기간본원76례MHD환자적림상자료,기록수후10년간사망환자적사망시간급원인；용Kaplan-Meier계산생존솔；Cox회귀분석cTnT、CRP급기타인소대환자장기예후적영향.결과 76례환자중CRP양성28례(36.8％),cTnT양성22례(28.9％)；중위생존시간위37.9개월；2년생존솔위65.9％,10년생존솔위24.2％.단인소분석결과현시,CRP양성、cTnT양성、노년、당뇨병、심뇌혈관질병、빈혈、저혈청백단백(Alb)、Kt/V하강여장기예후상관.다인소분석결과현시,년령증가(P=0.010)、심뇌혈관질병(P=0.048)、cTnT양성(P=0.036)、CRP양성(P=0.009)시영향투석환자10년생존솔적독립위험인소.cTnT양성조환자10년심뇌혈관질병병사솔여음성조차이무통계학의의(50.0％비35.4％,P=0.248),단2년심뇌혈관질병병사솔현저고우음성조(40.9％비14.6％,P=0.015).CRP양성조환자2년급10년심뇌혈관질병병사솔균고우음성조(48.1％비7.0％,P=0.000；66.7％비23.3％,P=0.000).여혈청cTnT급CRP쌍음성조환자상비,쌍양성조전인사망솔(92.9％비55.6％,P=0.030)、심뇌혈관질병병사솔(64.3％비25.0％,P=0.009)급2년내심뇌혈관질병병사솔(57.1％비5.6％,P=0.000)균교고.결론 노령、심뇌혈관질병、cTnT양성급CRP양성시영향MHD환자장기예후적독립위험인소.cTnT양성가이예측MHD환자2년내적심뇌혈관질병사망,이CRP양성칙동시가예측근기급원기심뇌혈관질병사망.cTnT여CRP쌍양성대우예측MHD환자근기급원기예후불량경유의의.
Objective To investigate the long-term prognostic factors and the significance of serum cardiac troponin T (cTnT) and C-reactive protein (CRP) in maintenance hemodialysis (MHD) patients.Methods Clinical data of 76 MHD patients in our hospital from January 2002 to January 2003 were retrospectively analyzed.Time and cause of death in the next 10 years were recorded.Survival rate was calculated by Kaplan-Meier and impact factors of long-term prognosis were explored.Significance of cTnT and CRP was elucidated by COX regression analysis.Results CRP was positive in 28 cases (36.8％) and cTnT was positive in 22 cases (28.9％) among 76 patients.The median survival time was 37.9 months,2-year survival rate was 65.9％ and 10-year survival rate was 24.2％.Univariate analysis found positive CRP,positive cTnT,old age,diabetes,cardiocerebrovascular disease,anemia,low serum albumin,Kt/V decline were associated with long-term prognosis.Multivariate analysis showed that increased age (P =0.010),cardiocerebrovascular disease (P =0.048),positive cTnT (P =0.036),positive CRP (P =0.009) were independent risk factors of the 10-year survival of MHD patients.Ten-year mortality of cardiocerebrovascular diseases in positive cTnT group was not significantly different as compared with negative cTnT group (50.0％ vs 35.4％,P =0.248).But the positive cTnT group had higher 2-year mortality than negative cTnT group (40.9％ vs 14.6％,P =0.015).Mortality of cardiocerebrovascular disease was higher in positive CRP group as compared to negative CRP group at both 2-year and 10-year time (48.1％ vs 7.0％,P =0.000; 66.7％ vs 23.3％,P =0.000).Compared with both negative cTnT and CRP group,both positive cTnT and CRP group had much higher all-cause mortality (92.9％ vs 55.6％,P =0.030),higher mortality of cardiocerebrovascular disease at 10-year (64.3％ vs 25.0％,P =0.009),and higher mortality of cardiocerebrovascular disease at 2-year (57.1％ vs 5.6％,P =0.000).Conclusions Aging,cardiocerebrovascular disease,positive cTnT and positive CRP are independent risk factors of long-term prognosis for MHD patients.Positive cTnT can predict cardiocerebrovascular mortality of MHD patients in 2 years,while positive CRP can predict short-and long-term cardiocerebrovascular mortality.Positive cTnT combined with positive CRP may be more valuable in predicting the poor prognosis of MHD patients.