Koh Eun Sil, Lee Kyungsoo, Kim Su Hyun, Kim Young Ok, Jin Dong Chan, Song Ho Chul, Choi Euy Jin, Kim Yong Lim, Kim Yon Su, Kang Shin Wook, Kim Nam Ho, Yang Chul Woo, Kim Yong Kyun
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Am J Nephrol. 2015;42(2):91-8. doi: 10.1159/000439060. Epub 2015 Sep 5.
BACKGROUND/AIMS: β2-Microglobulin (β2-M) is a surrogate marker of middle-molecule uremic toxins and is associated with mortality in chronic hemodialysis patients. However, the impact of serum β2-M levels on mortality in peritoneal dialysis (PD) patients is uncertain. The purpose of this study was to examine the association of serum β2-M levels with all-cause mortality in PD patients.
A total of 771 PD patients were selected from the Clinical Research Center registry for end-stage renal disease cohort in Korea. Patients were categorized into 3 groups by tertiles of serum β2-M levels. The primary outcome was all-cause mortality.
The median value of serum β2-M was 23.6 mg/l (interquartile range 14.8-33.4 mg/l), and the median follow-up period was 39 months. The Kaplan-Meier analysis showed that the all-cause mortality rate was significantly different according to tertiles of serum β2-M in PD patients (p=0.03, log-rank). Multivariate Cox proportional analysis showed that the hazards ratio for all-cause mortality was 1.02 (95% CI 1.01-1.04, p=0.006) per 1 mg/l increase in β2-M after adjustment for multiple confounding factors that relate to malnutrition and inflammation marker. However, serum β2-M was not associated with all-cause mortality after adjustment for residual renal clearance.
These results are supportive of the potential role of the serum β2-M level as a predictor of mortality in PD patients.
背景/目的：β2微球蛋白（β2-M）是中分子尿毒症毒素的替代标志物，与慢性血液透析患者的死亡率相关。然而，血清β2-M水平对腹膜透析（PD）患者死亡率的影响尚不确定。本研究的目的是探讨血清β2-M水平与PD患者全因死亡率的相关性。
从韩国终末期肾病队列临床研究中心登记处选取771例PD患者。根据血清β2-M水平的三分位数将患者分为3组。主要结局是全因死亡率。
血清β2-M的中位数为23.6mg/l（四分位间距14.8-33.4mg/l），中位随访期为39个月。Kaplan-Meier分析显示，PD患者中，根据血清β2-M的三分位数，全因死亡率有显著差异（p=0.03，对数秩检验）。多因素Cox比例分析显示，在调整了与营养不良和炎症标志物相关的多个混杂因素后，β2-M每升高1mg/l，全因死亡率的风险比为1.02（95%CI 1.01-1.04，p=0.006）。然而，在调整残余肾清除率后，血清β2-M与全因死亡率无关。
这些结果支持血清β2-M水平作为PD患者死亡率预测指标的潜在作用。
