摘要目的 探讨血液透析患者低血清间接胆红素(IBIL)水平与全因死亡的关系.方法 纳入2015年6月至2016年6月于贵州省7家血液透析中心行维持性血液透析(MHD)治疗3个月以上的成人患者.收集并记录患者人口学资料、稳定透析3个月以上的临床及实验室检查作为基线数据.根据基线血清IBIL水平四分位数将所有患者分为4组(Q1～Q4组),并随访至2018年6月30日.采用Kaplan-Meier法比较各组患者生存率,Cox回归模型分析IBIL与全因死亡的相关性.结果 共885例具有基线IBIL数据的血液透析患者被纳入研究,年龄(55.4±16.2)岁,其中男512例(57.9％),IBIL水平为4.8(3.3,7.0) μmol/L.四组间糖尿病患者比例、血红蛋白、血清白蛋白、血小板、血钙、丙氨酸转氨酶、血尿酸和血尿素氮水平差异均有统计学意义(均P＜0.05).经过中位24个月的随访,210例患者死亡,96例失访.Kaplan-Meier生存曲线显示Q1组(基线血清IBIL≤3.3 μmol/L)患者生存率较低(P=0.015).经性别、年龄、合并症及生化指标等校正后,以Q2组(IBIL 3.4～4.8 μmol/L)为参照,基线血清IBIL≤3.3 μmol/L的患者全因死亡的风险比为1.661(95％CI:1.114～2.476,P=0.013).Kaplan-Meier生存曲线显示,按血清总胆红素或直接胆红素四分位数分组,比较各组间全因死亡率差异均无统计学意义(P=0.167、0.156).结论 血液透析患者基线低血清IBIL水平与全因死亡相关.

abstractsObjective To investigate the association of low serum indirect bilirubin (IBIL) level with all-cause mortality in maintenance hemodialysis (MHD) patients.Methods A multicenter retrospective cohort study was conducted in seven hemodialysis centers of Guizhou province.The adult outpatients who underwent hemodialysis for more than 3 months were included between June 2015 and June 2016.Demographics,baseline clinical and laboratory test results were collected.Patients were divided into 4 groups according to their baseline serum IBIL levels (interquartile range),and followed up until June 30,2018.Kaplan-Meier method was used to compare the survival rate of each group.Cox regression model was used to analyze the association of IBIL with all-cause mortality.Results A total of 885 hemodialysis dialysis patients with baseline IBIL data were enrolled in this study,with age of (55.4± 16.2) years old,among whom 57.9％ (512/885) were male.Median IBIL was 4.8 μmol/L and interquartile range was 3.3-7.0 μmol/L.The comparison between IBIL quartile groups showed that the differences in proportion of diabetics,hemoglobin,serum albumin,platelet,serum calcium,alanine aminotransferase (ALT),uric acid and urea nitrogen were statistically significant (all P＜0.05).After a median follow-up of 24 months,210 patients died,and 96 cases became lost to follow-up.Kaplan-Meier curves showed higher all-cause mortality in patients with IBIL≤3.3 μmol/L (Q1 group) (65/219,P=0.015).After adjusting for age,gender,comorbidities,and biochemical indicators,taking baseline IBIL Q2 level (IBIL 3.4～4.8 μnol/L) as a reference,the hazard ratio for all-cause death in patients with IBIL≤3.3 μmol/L was 1.661 (95％CI:1.114-2.476,P=0.013).Kaplan-Meier survival curve showed that there was no significant difference in mortality between the quartile groups according to total bilirubin (TBIL) or direct bilirubin (DBIL) (P=0.167,0.156).Conclusion Baseline low serum IBIL in maintenance hemodialysis patients is associated with all-cause mortality.