Objective To study the effect of maintenance hemodialysis (MHD) patients complicated with malnutrition, inflammation and atherosclerosis (MIA) syndrome on the prognosis.Methods The patients were recruited who have made MHD for more than three months in Hemopurification Center of our hospital between January, 2013 and January, 2016.If his or her serum albumin was <35 g/L, malnutrition was defined;If his or her C-reactive protein was ≥8 mg/L, micro-inflammation was defined.The cerebrovascular diseases include coronary artery diseases, peripheral vascular diseases and cerebrovascular diseases.The patients were divided into two groups based on above standards: observation group and control group.The survival rate and all-cause mortality risk in one year, two years and three years were compared.Results There were 71 patients in observation group [45 males and 26 females;mean age of (60.1±15.1) years;mean hemodialysis vintage of (62.75±36.87) months;mean hemoglobin of (96.56±17.27) g/L], and there were 185 patients in control group [110 males and 75 females;mean age of (55.8±15.4) years;mean hemodialysis vintage of (51.43±27.74) months;mean hemoglobin of (106.09±18.3) g/L].The patients were older [(60.1±15.1) vs.(55.8±15.4), P<0.05], hemodialysis vintage was longer [(62.75±36.87) vs.(51.43±27.74), P<0.05], and hemoglobin was lower [(96.56±17.27) vs.(106.09±18.3), P<0.05] in observation group than in control group.The one-, two-and three-year survival rate was 99.5%, 94.1% and 88.1% in control group, and 95.8%, 83.1% and 80.3% in observation group, respectiely.The survival rate in observation group was obviously lower than in control group (Log rank13.419, P=0.000).As compared with control group, the all-cause mortality risk of patients in observation group was 2.86 (95% CI, 1.59-5.17, P=0.000), which still had statistical significance after adjustment (HR 2.18, 95% CI, 1.13-4.21, P=0.210).Conclusions The MIA syndrome existing in MHD patients is an independent risk factor for their all-cause mortality, which significantly impacts the long-term prognosis of the HD patients, and is an important reason for the increased fatality rate.%目的 探讨营养不良-炎症-动脉粥样硬化(malnutrition-inflammation-atherosclerosis syndrome,MIAS)综合征对维持性血液透析患者预后的影响.方法 选择2013年1月至2016年1月在第三军医大学大坪医院血液净化中心维持性血液透析3个月以上的患者256例,收集患者C反应蛋白、白蛋白、脑钠肽、血红蛋白、血钙、血磷、全段甲状旁腺素、β2-微球蛋白、Kt/V水平等.将白蛋白<35 g/L定义为营养不良,C反应蛋白≥8 mg/L定义为存在微炎症,动脉粥样硬化包括冠状动脉疾病、外周血管疾病以及脑血管疾病;根据以上标准将入选患者分成合并MIAS组(即观察组)及无MIAS组(即对照组).比较2组患者的临床基础资料及1年、2年、3年生存率和全因死亡风险.结果 观察组71例,其中男45例,女26例,平均年龄(60.1±15.1)岁,透析时间(62.75±36.87)个月,血红蛋白(96.56±17.27)g/L;对照组185例,其中男110例,女75例,平均年龄(55.8±15.4)岁,平均透析时间(51.43±27.74)个月,Hb(106.09±18.3)g/L.与对照组比较,观察组患者年龄偏大、透析时间较长、Hb较低,均有统计学差异(P<0.05).2组患者的1、2、3年生存率分别为:对照组99.5%、94.1%、88.1%,观察组95.8%、83.1%、80.3%.观察组患者的生存率显著低于对照组(Log rank13.419,P=0.000).与对照组相比,观察组患者全因死亡风险为2.86(95%CI1.59~5.17,P=0.000),经校正后仍然有统计学意义(HR2.18, 95%CI1.13~4.21,P=0.021).结论 维持性血液透析患者存在的MIAS是患者全因死亡独立危险因素,明显影响透析患者的长期预后,是病死率增高的重要原因.
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