| 引用本文： |
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马亚静,赵歆晖,吴艳芬,等.糖尿病与血液透析患者心血管预后的关系[J].同济大学学报（医学版）,2022,43(3):331-337. [点击复制]
- MA Yajing,ZHAO Xinhui,WU Yanfen,et al.All-cause mortality, cardiovascular mortality and cardiovascular events in diabetic patients with maintenance hemodialysis[J].同济大学学报（医学版）,2022,43(3):331-337. [点击复制]
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| 摘要: |
| 目的探讨糖尿病（diabetes mellitus, DM）对维持性血液透析（maintenance hemodialysis, MHD）患者全因、心血管死亡和非致死性心血管事件的影响。方法选取2015年4月1日—2015年9月1日在上海市浦东新区人民医院、上海市浦东医院接受规律血液透析的患者为研究对象，所有患者均随访至死亡、失访或至本研究截止日期，收集期间患者心血管不良事件及死亡原因。采用Cox回归模型分析DM与死亡、心血管预后的关系，结果采用风险比例（hazard ratios, HR）及95%可信区间（confidence intervals, CI）表示。结果最终367例MHD患者入选，DM组118例，非DM组249例。随访期间共87（23.7%）例患者死亡，其中合并DM患者死亡45例、心血管死亡27例及非致死性心血管事件64例。Kaplan-Meier生存分析显示DM组的全因、心血管死亡率及非致死性心血管事件发生率明显高于非DM组（均P<0.001）。多因素Cox回归分析显示，合并DM是全因死亡（HR=1.74,95%CI: 1.06~2.88）、心血管死亡（HR=2.17,95%CI: 1.01~4.64）、非致死性心血管事件（HR=1.72，95%CI: 1.19~2.48）的独立危险因素。MHD患者中全因死亡（HR=0.92,95%CI: 0.86~0.98）及心血管死亡（HR=0.90,95%CI: 0.82~0.98）风险与血浆白蛋白水平有关。结论合并DM是MHD患者全因、心血管死亡和非致死性心血管事件的独立危险因素，降低DM发病率可能改善MHD患者预后。 |
| 关键词: 维持性血液透析 糖尿病 心血管预后 |
| DOI：10.12289/j.issn.1008-0392.21307 |
| 投稿时间：2021-07-14 |
| 基金项目:上海市浦东新区卫生系统领先人才培养计划（PWR12019-08） |
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| All-cause mortality, cardiovascular mortality and cardiovascular events in diabetic patients with maintenance hemodialysis |
| MA Yajing,ZHAO Xinhui,WU Yanfen,ZHOU Dongchi,JIN Huimin,QI Hualin |
| (Department of Nephrology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China;Department of Nephrology, Pudong New Area People’s Hospital, Shanghai 200120, China;Department of Nephrology, Pudong Hospital, Shanghai 201399, China) |
| Abstract: |
| ObjectiveTo investigate the all-cause mortality, cardiovascular mortality and cardiovascular events in diabetic patients with maintenance hemodialysis（MHD）. MethodsA total of 367 patients receiving regular hemodialysis in Pudong New Area People’s Hospital and Pudong Hospital from April 2015 to September 2015 were enrolled in the study. All patients were followed up until death, loss of follow-up, or the deadline of this study（September 1, 2019）, and the cardiovascular events and causes of death were recorded. A Cox regression model was used to analyze the association of DM with mortality or cardiovascular events. ResultsAmong 367 MHD patients, there were 118 patients with diabetes mellitus（DM group） and 249 patients withour DM（non-DM group）. During the follow-up period, there were total 87 deaths（23.7%）. In DM group there were 45 deaths including 27 cardiovascular deaths, and 64 nonfatal cardiovascular events. Kaplan-Meier curve showed that the rate of all-cause mortality and cardiovascular events or cardiovascular mortality were significantly higher in DM group（P<0.001） than those in non-DM group. Multivariable Cox regression and the competing risk model showed that DM was an independent risk factor for all-cause mortality（HR=1.74,95%CI： 1.06-2.88） and cardiovascular events（HR=1.72，95%CI： 1.19-2.48） and cardiovascular mortality（HR=2.17,95%CI： 1.01-4.64）; while the plasma albumin level was a protective factor for all-cause mortality（HR=0.92,95%CI： 0.86-0.98） and cardiovascular mortality（HR=0.90,95%CI： 0.82-0.98） in MHD patients. ConclusionDiabetes mellitus is an independent risk factor for all-cause mortality, cardiovascular mortality and cardiovascular events in MHD patients. |
| Key words: maintenance hemodialysis diabetes mellitus cardiovascular prognosis |
