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目的通过对维持性血液透析(MHD)患者营养和炎症相关指标的回顾性分析,探讨营养不良-炎症复合体综合征(MICS)与MHD患者预后的关系。方法入选2007年1月1日—2014年12月31日在上海交通大学医学院附属仁济医院血透中心接受MHD治疗≥3个月的患者527例,分为MICS组和非MICS组。采用logistic回归分析MHD患者并发MICS的危险因素,Kaplan-Meier分析MHD患者生存率,Cox比例风险模型分析MICS患者全因死亡和心血管疾病死亡的危险因素。结果527例患者中MICS患者441例(83.63%),MICS组患者年龄较大、BMI较高、透析龄较长、血红蛋白较低。多因素logistic回归显示年龄增长、透析龄增加、血红蛋白<100 g/L是MHD患者并发MICS的独立危险因素。Kaplan-Meier分析显示MICS患者全因病死率(Log-Rank检验,P=0.040)及心血管疾病病死率(Log-Rank检验,P=0.038)明显高于非MICS患者。Cox回归显示年龄增长、透析龄增加、血红蛋白低、总胆固醇降低、低密度脂蛋白升高是预测MICS患者全因死亡及心血管疾病死亡的独立危险因素。结论 MHD患者MICS患病率高;并发MICS预后较非MICS差;贫血与MICS的发生及预后密切相关。
Objective To investigate the relationship between malnutrition - inflammatory complex syndrome (MICS) and the prognosis of patients with MHD by retrospective analysis of nutritional and inflammation-related indicators in maintenance hemodialysis (MHD) patients. Methods One hundred and fifty-seven patients with MHD ≥3 months who received MHD at the Hemodialysis Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, from January 1, 2007 to December 31, 2014 were divided into MICS group and non-MICS group. Multivariate logistic regression analysis was used to analyze the risk factors of MICS complicated with MHD. Kaplan-Meier analysis was used to analyze the survival rate of MHD patients. Cox proportional hazard model was used to analyze the risk factors of all-cause mortality and cardiovascular death in MICS patients. Results Among the 527 patients, 441 (83.63%) were MICS patients. MICS patients were older, had higher BMI, longer dialysis age and lower hemoglobin. Multivariate logistic regression showed that age was increased and dialysis age was increased. Hemoglobin <100 g / L was an independent risk factor for MICS complicated by MHD. Kaplan-Meier analysis showed that all-cause mortality (Log-Rank test, P = 0.040) and cardiovascular mortality (Log-Rank test, P = 0.038) were significantly higher in MICS patients than in non-MICS patients. Cox regression showed that age, dialysis age, low hemoglobin, total cholesterol and low density lipoprotein were independent predictors of all-cause mortality and cardiovascular death in MICS patients. Conclusions The prevalence of MICS in MHD patients is high. The prognosis of complicated MICS is worse than that of non-MICS. Anemia is closely related to the occurrence and prognosis of MICS.