【摘要】 目的探讨血清钙结合蛋白(CPT)与伴高磷血症的血液透析患者全因死亡风险的关系。方法选取373例伴高磷血症的持续性血液透析患者,收集所有患者基线临床资料[年龄、性别、体质量指数(BMI)、踝肱指数(ABI)、吸烟史、合并疾病等]和实验室检测结果[白细胞计数(WBC)计数、高敏C反应蛋白(hs-CRP)、血小板(PLT)计数、白蛋白(Alb)、尿素氮、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)],同时检测血清CPT,依据CPT水平将所有患者分为低CPT组、中等CPT组和高CPT组。对所有患者进行随访,随访时间为4～80个月,随访终点为死亡、行肾移植或完成随访。以Pearson相关分析评估各项指标与CPT水平的相关性。采用Cox回归分析评估CPT水平与血液透析患者死亡的关系。结果 373例伴高磷血症的持续性血液透析患者血清CPT水平为6.1(4.3～8.7)ng/L,男性显著高于女性(P<0.01),有无吸烟史、有无合并疾病(糖尿病、冠状动脉疾病、卒中、外周动脉疾病)之间患者血清CPT水平差异均无统计学意义(P>0.05)。相关性分析结果显示,CPT与透析时间呈负相关(r=-0.174,P<0.001),与BMI、WBC计数、hs-CRP、PLT计数、TG呈正相关(r值分别为0.192、0.553、0.378、0.329、0.270,P<0.05),与Alb、LDL-C无相关性(r值分别为0.092、-0.005,P>0.05)。Kaplan-Meier生存曲线分析结果显示,高CPT组中位生存时间显著短于低CPT组和中等CPT组(P<0.001)。与中等CPT组比较,校正年龄、性别、BMI、高血压史、糖尿病史、血脂异常、透析时间和吸烟史后,低CPT组全因死亡风险降低了11%[风险比(HR)=0.89,95%可信区间(CI)为0.78～0.98,P=0.03];高CPT组死亡风险增加了70%(HR=1.70,95%CI为1.52～2.33,P=0.001)。结论血清CPT水平与伴高磷血症血液透析患者的死亡风险有关。更多还原

【Abstract】 Objective To investigate the correlation between serum calbindin(CPT) and the risk of all-cause death in hemodialysis patients with hyperphosphatemia. Methods Totally,373 continuous hemodialysis patients with hyperphosphatemia were enrolled. The baseline clinical data of all the patients [age,sex,body mass index(BMI),ankle brachial index(ABI),smoking history,combined diseases and so on] and clinical laboratory test data [white blood cell(WBC) count,high-sensitivity C-reactive protein(hs-CRP),platelet(PLT),albumin(Alb),urea nitrogen,low-density lipoprotein cholesterol(LDL-C),triglyceride(TG)] were collected.Serum CPT was determined. All the patients were classified into low CPT group,medium CPT group and high CPT group according to CPT levels. All the patients were followed up for 4-80 months. The endpoint of follow-up was death,renal transplantation or follow-up completion. Pearson correlation analysis was used to evaluate the correlation between various indexes and CPT levels. Cox regression analysis was used to evaluate the relationship between death risk and CPT level in hemodialysis patients. Results Serum CPT level of 373 continuous hemodialysis patients with hyperphosphatemia was 6.1(4.3-8.7) ng/L. Serum CPT in males was higher than that in females(P<0.01).There was no statistical significance in serum CPT levels whether with smoking history,diabetes mellitus history,coronary artery disease history,stroke history and peripheral arterial disease history or not(P>0.05). The results of correlation analysis showed that CPT was negatively correlated with dialysis time(r=-0.174,P<0.001). It was positively correlated with BMI,WBC count,hs-CRP,PLT count and TG(r values were 0.192,0.553,0.378,0.329 and 0.270,P<0.05),and there was no correlation with Alb and LDL-C(r values were 0.092 and-0.005,P>0.05). Kaplan-Meier curve analysis indicated that the median survival time of patients in high CPT group was shorter than those in low and medium CPT groups(P<0.001). Compared with medium CPT group,the risk of death in low CPT group decreased by 11% [hazard ratio(HR)=0.89,95% confidence interval(CI) 0.78-0.98,P=0.03]after adjusting for age,sex,BMI,hypertension history,diabetes mellitus history,dyslipidemia,dialysis time and smoking history. The risk of death increased by 70% in high CPT group(HR=1.70,95%CI 1.52-2.33,P=0.001).Conclusions The level of serum CPT is related to the risk of death in hemodialysis patients with hyperphosphatemia.更多还原