Sueta Daisuke, Hokimoto Seiji, Sakamoto Kenji, Akasaka Tomonori, Tabata Noriaki, Kaikita Koichi, Honda Osamu, Naruse Masahiro, Ogawa Hisao
Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
Int J Cardiol. 2017 Mar 1;230:97-102. doi: 10.1016/j.ijcard.2016.12.072. Epub 2016 Dec 21.
Malnutrition-Inflammation-Atherosclerosis (MIA) factors significantly and independently affect life prognosis of hemodialysis (HD) patients. We re-evaluated Japanese data, which have progressed ahead from a community-based observational study. The present study was designed to assess the contribution of these MIA factors to the mortality rate of Japanese HD patients in a community of 1.8 million people over a 36-month follow-up period.
A total of 5813 patients at 76 facilities were on maintenance HD in the Kumamoto Prefecture. Specifically, 4807 of these patients at 58 institutions were enrolled. Patients who exhibited lower serum albumin and higher serum C-reactive protein levels were defined as "malnourished" and "inflamed", respectively, compared with the median values. Patients who underwent invasive procedures for atherosclerotic diseases were defined as "atherosclerotic". The 36-month all-cause mortality rate in Japanese HD patients was 12.4%. This rate directly correlated with the number of MIA factors. The odds ratio of the all-cause mortality rate markedly and significantly increased as the number of factors increased. The presence of 3 MIA factors in HD patients was a significant predictor of mortality, as evidenced by a multivariate logistic regression analysis.
This study clearly demonstrated the close association between MIA syndrome and high mortality in Japanese HD patients. Early detection and the adjustment of MIA factors are mandatory.
营养不良-炎症-动脉粥样硬化（MIA）因素显著且独立地影响血液透析（HD）患者的生命预后。我们重新评估了日本的数据，这些数据来自一项基于社区的观察性研究，且已取得进展。本研究旨在评估这些MIA因素在一个拥有180万人口的社区中，对日本HD患者36个月随访期内死亡率的影响。
熊本县76家机构共有5813例患者接受维持性血液透析。具体而言，来自58家机构的4807例患者被纳入研究。与中位数相比，血清白蛋白水平较低和血清C反应蛋白水平较高的患者分别被定义为“营养不良”和“炎症”。接受过动脉粥样硬化疾病侵入性治疗的患者被定义为“动脉粥样硬化”。日本HD患者36个月的全因死亡率为12.4%。该比率与MIA因素的数量直接相关。随着因素数量的增加，全因死亡率的比值比显著且明显升高。多因素逻辑回归分析表明，HD患者存在3个MIA因素是死亡率的显著预测指标。
本研究清楚地证明了日本HD患者中MIA综合征与高死亡率之间的密切关联。必须尽早发现并调整MIA因素。
