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血清胱抑素C和超敏C反应蛋白对维持性血液透析患者3年生存情况的影响分析

Impact of serum cystatin C and hypersensitivity C-reactive protein on the 3-year survival of patients undergoing maintenance hemodialysis

    摘要
  • 摘要:
    目的 探讨血清胱抑素C(Cys-C)与超敏C反应蛋白(hs-CRP)水平对维持性血液透析(MHD)患者3年生存情况的影响。
    方法 选择2011年4月—2020年10月在南通大学第二附属医院就诊的358例慢性肾衰竭患者为研究对象，所有患者均接受MHD。记录患者一般临床资料、透析前实验室检查指标、透析后3个月超声心动图指标。随访患者透析3年后生存情况，比较存活患者和死亡患者的一般临床资料、透析前实验室检查指标以及透析后3个月的超声心动图指标。采用单因素和多因素Cox回归分析筛选MHD患者3年生存情况的影响因素。
    结果 3年随访时, 302例MHD患者中203例存活, 99例死亡。存活患者与死亡患者的年龄、原发疾病、糖尿病情况、充血性心力衰竭情况、他汀类药物使用、抗血小板药物使用、利尿药使用、透析方式、谷氨酰转移酶(GGT)、碱性磷酸酶(AKP)、总胆红素(TBIL)、β2-微球蛋白(β2-MG)、肌酐(Cr)、估算肾小球滤过率(eGFR)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)和血清磷(P)水平比较，差异均有统计学意义(P < 0.05或P < 0.01)。单因素Cox回归分析结果显示, MHD患者年龄、原发疾病(糖尿病肾病、高血压肾病、多囊肾、其他)、合并症(糖尿病、充血性心力衰竭、其他心血管疾病)、药物使用情况(他汀类药物、抗血小板药物)、透析方式(血液透析滤过、血液透析+血液灌注)、实验室检查指标GGT、AKP、TBIL、总胆汁酸(TBA)、白蛋白(ALB)、Cr、Cys-C、eGFR、载脂蛋白A(APO-A)、hs-CRP均是MHD患者3年生存率的影响因素; 多因素Cox回归模型分析结果显示，年龄、原发疾病、其他心血管疾病、透析方式、AKP、ALB、TBIL、Cys-C和hs-CRP是慢性肾衰竭患者生存情况的重要影响因素(P < 0.05)。
    结论 慢性肾衰竭患者MHD治疗前血清Cys-C和hs-CRP水平可能与透析治疗3年生存情况有关，高血清Cys-C可能降低患者临床预后不良风险，而高血清hs-CRP可能增高患者临床预后不良风险。

     

    Abstract:
    Objective To investigate the influence of serum cystatin C (Cys-C) and hypersensitivity C-reactive protein (hs-CRP) levels on the 3-year survival of patients undergoing maintenance hemodialysis (MHD).
    Methods A total of 358 patients with chronic renal failure who underwent MHD at the Second Affiliated Hospital of Nantong University from April 2011 to October 2020 were selected as study subjects. General clinical data, pre-dialysis laboratory test indicators, and echocardiographic indicators 3 months after dialysis were recorded. The survival status of patients after 3 years of dialysis was followed up, and the general clinical data, pre-dialysis laboratory test indicators, and echocardiographic indicators 3 months after dialysis were compared between surviving and deceased patients. Univariate and multivariate Cox regression analyses were performed to screen influencing factors of 3-year survival in MHD patients.
    Results At the 3-year follow-up, of the 302 MHD patients' 203 survived, and 99 died. Statistically significant differences were observed in age, primary disease, diabetes status, congestive heart failure, statin use, antiplatelet drug use, diuretic use, dialysis mode, estimated glomerular filtration rate (eGFR) and gamma-glutamyl transferase (GGT), alkaline phosphatase (AKP), total bilirubin (TBIL), β2-microglobulin (β2-MG), creatinine (Cr), low-density lipoprotein cholesterol (LDL-C), hypersensitive C-reactive protein (hs-CRP), and serum phosphorus (P) levels between surviving patients and deaths(P < 0.05 or P < 0.01). Univariate Cox regression results showed that age of MHD patients, primary disease (diabetic nephropathy, hypertensive nephropathy, polycystic kidney disease, others), comorbidities(diabetes, congestive heart failure, other cardiovascular diseases), drug use (statins, antiplatelet drugs), dialysis method (hemodialysis, hemodialysis + perfusion), laboratory test indicators GGT, AKP, TBIL, total bile acid (TBA), albumin (ALB), Cr, Cys-C, eGFR, apolipoprotein A (APO-A), hs-CRPwere all influential factors of 3-year survival rate of MHD patients. Multivariate Cox regression analysis revealed that age, primary disease, other cardiovascular diseases, dialysis mode, AKP, ALB, TBIL, Cys-C, and hs-CRP were significant influencing factors for the survival of patients with chronic renal failure (P < 0.05).
    Conclusion Serum Cys-C and hs-CRP levels before MHD in patients with chronic renal failure may be associated with their 3-year survival after dialysis treatment. High serum Cys-C may reduce the risk of poor clinical prognosis, while high serum hs-CRP may increase the risk of poor clinical prognosis.

     

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