Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Clin Nutr. 2012 Oct;31(5):630-6. doi: 10.1016/j.clnu.2012.02.008. Epub 2012 Mar 8.
BACKGROUND & AIMS: Essential trace elements are involved in many biological processes for normal cell function including immunological defense against oxidation and infection. Deficiency of these elements generally leads to illness or even death in the general population. Therefore, we investigated the predictive values of trace element status on clinical outcomes in dialysis patients, who are more prone to trace element deficiency.
We enrolled 111 prevalent patients on maintenance dialysis from a Taipei tertiary-care referral hospital and measured serum levels of selenium, copper, and zinc. Patients were followed for 2 years or until death or withdrawal.
Multivariate Cox regression analysis indicated that patients with diabetes mellitus (HR, 2.162 [95% CI, 1.105-4.232], p=0.024), prior stroke (HR, 3.876 [95% CI, 1.136-13.221], p=0.030), and zinc deficiency (HR, 0.979 [95% CI, 0.966-0.992], p=0.002) were more likely to be hospitalized for infectious diseases. Furthermore, beyond traditional risk factors, such as old age and hypoalbuminemia, multivariate Cox regression also indicated that lower serum level of zinc independently predicts overall mortality (HR, 0.973 [95% CI, 0.948-0.999], p=0.046).
In long-term dialysis patients, the serum level of zinc was an independent predictor of future hospitalization due to infectious diseases and of overall mortality.
必需微量元素参与许多正常细胞功能的生物过程，包括免疫防御氧化和感染。这些元素的缺乏通常会导致普通人群患病甚至死亡。因此，我们研究了微量元素状态对透析患者临床结局的预测价值，透析患者更容易缺乏微量元素。
我们从台北一家三级转诊医院招募了 111 名维持性透析的现患患者，并测量了血清硒、铜和锌水平。对患者进行了 2 年的随访，直至死亡或退出。
多变量 Cox 回归分析表明，患有糖尿病（HR，2.162[95%CI，1.105-4.232]，p=0.024）、既往卒中（HR，3.876[95%CI，1.136-13.221]，p=0.030）和锌缺乏症（HR，0.979[95%CI，0.966-0.992]，p=0.002）的患者更有可能因感染性疾病住院。此外，除了传统的危险因素，如年龄较大和低白蛋白血症外，多变量 Cox 回归还表明，血清锌水平较低独立预测总体死亡率（HR，0.973[95%CI，0.948-0.999]，p=0.046）。
在长期透析患者中，血清锌水平是未来因感染性疾病住院和总体死亡率的独立预测因素。
