【摘要】 目的 探讨低血清磷和低甲状旁腺激素（PTH）水平对维持性血液透析（MHD）患者蛋白质能量消耗（PEW）及预后的影响。方法 本研究采用多中心横断面设计，纳入2021年6—9月17个透析中心的400例透析时间>3个月的终末期肾脏病（ESRD）患者。正态分布的连续变量以xˉ±s表示，采用单因素方差分析；非正态分布者以M(Q1,Q3)表示，采用Wilcoxon秩和检验。分类变量用例数（%）表示，采用χ2检验。采用logistic回归分析血清磷和PTH水平与PEW的相关性，通过ROC评估其预测价值，并采用Kaplan-Meier法评价其对生存率的影响。结果 400例MHD患者中PEW发生率为40%(160/400)。按血清磷四分位分组分析显示，Q1（最低四分位）PEW患病率达91%，营养指标（前白蛋白、血红蛋白、上臂围、握力、瘦体组织质量）随四分位升高而改善（P均<0.05）。从PTH水平四分位分析显示，Q1组的握力和瘦体组织质量明显低于其他3组，Q1组的PEW患病率为49%，高于其他3组。校正混杂因素后，血清磷Q1组的PEW风险是Q4组的2.232倍（95%CI:1.915～2.601,P<0.001）,Q2组是Q4组的1.202倍（95%CI:1.035～1.397,P=0.016）;PTH Q1组的PEW风险是Q4组的1.278倍（95%CI:1.030～1.585,P=0.026）。ROC分析显示，血清磷和PTH预测MHD患者PEW的AUC分别为0.862、0.695；最佳截断值分别为1.36 mmol/L和212.5 ng/L。Kaplan-Meier生存曲线显示，血清磷≤1.36 mmol/L且PTH≤212.5 ng/L的患者生存率明显降低。结论 低血磷及低甲状旁腺激素水平可增加MHD患者PEW的发生和死亡风险，影响血液透析患者的预后。更多还原

【Abstract】 Objective To investigate the impact of low serum phosphorus and low parathyroid hormone(PTH) levels on protein-energy wasting(PEW) and prognosis in maintenance hemodialysis(MHD) patients. Methods This study adopted a multicenter cross-sectional design,enrolling 400 end-stage renal disease(ESRD) patients with dialysis duration>3 months from 17dialysis centers between June and September 2021. Normally distributed continuous variables were expressed as xˉ±s, analyzed by one-way analysis of variance; non-normally distributed variables were presented as median M(Q1, Q3), analyzed by Wilcoxon rank-sum test. Categorical variables were described as count(%) and analyzed by χ2 test. Logistic regression was used to analyze the correlation between serum phosphorus/PTH levels and PEW, receiver operating characteristic(ROC) curve to evaluate their predictive value, and Kaplan-Meier method to assess their impact on survival rate.Results The incidence of PEW was 40%(160/400) in MHD patients. Analysis by serum phosphorus quartiles showed that the PEW prevalence in Q1(lowest quartile) reached 91%, and nutritional indices(prealbumin, hemoglobin, mid-upper arm circumference, grip strength, lean body mass)improved with increasing quartiles(all P<0.05). For PTH quartiles, grip strength and lean body mass in Q1 were significantly lower than those in the other three groups, and the PEW prevalence in Q1(49%) was higher than others. After adjusting for confounders, the PEW risk in serum phosphorus Q1was 2.232-fold that in Q4(95%CI:1.915-2.601,P<0.001), and Q2 was 1.202-fold(95%CI:1.035-1.397,P=0.016); PTH Q1 had a 1.278-fold PEW risk compared with Q4(95% CI:1.030-1.585,P=0.026). ROC analysis showed area under the curve(AUC) of serum phosphorus and PTH for predicting PEW were 0.862 and 0.695, with optimal cut-offs of 1.36 mmol/L and 212.5 ng/L, respectively. Kaplan-Meier survival curves showed significantly lower survival rates in patients with serum phosphorus ≤1.36mmol/L and PTH ≤212.5 ng/L. Conclusion Low serum phosphorus and low PTH levels increase the risk of PEW and mortality in MHD patients, affecting their prognosis.更多还原