维生素 K 状态与腹膜透析患者死亡率和心血管事件的关系。
Associations of vitamin K status with mortality and cardiovascular events in peritoneal dialysis patients.
机构信息
Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Guangdong, People's Republic of China.
Department of Nephrology, Central Municipal Hospital of Huizhou, Guangdong, People's Republic of China.
出版信息
Int Urol Nephrol. 2019 Mar;51(3):527-534. doi: 10.1007/s11255-019-02080-x. Epub 2019 Jan 28.
PURPOSE
Vitamin K deficiency, expressed by a high level of desphospho-uncarboxylated matrix GLA protein (dp-ucMGP), is highly prevalent in dialysis patients. However, the predictive ability of the vitamin K status remains unclear in continuous ambulatory peritoneal dialysis (CAPD) patients.
METHODS
158 prevalent CAPD patients with a median level of dp-ucMGP of 1093 (752, 1485) pmol/L were enrolled. Patient outcomes including all-cause mortality and cardiovascular events (CVEs) were recorded during follow-up. Survival curves were performed using Kaplan-Meier method, and the influences of dp-ucMGP on outcomes were analyzed by Cox regression models.
RESULTS
A total of 59 deaths and 82 new episodes of CVEs occurred during median follow-up of 31.4 ± 13.1 months (range: 3.8-48.0 months). Kaplan-Meier analysis revealed patients with higher dp-ucMGP levels (≥ 1093 pmol/L) had an increased risk for both mortality (P = 0.005) and CVEs (P < 0.001). Multivariable Cox regression confirmed that higher dp-ucMGP levels increase the mortality risk [hazard ratio (HR), 1.763; 95% CI 1.045-3.291] and CVEs (HR, 1.846; 95% CI 1.074-3.172). For every 100 pmol/L increase in serum dp-ucMGP, the adjusted HRs for mortality and CVEs were 1.054 (95% CI 1.008-1.106) and 1.034 (95% CI 1.012-1.089), respectively.
CONCLUSIONS
Vitamin K deficiency, as expressed by high dp-ucMGP levels, showed independently associations with mortality and CVEs in CAPD patients.
目的
维生素 K 缺乏症表现为无羧基化基质 GLA 蛋白（dp-ucMGP）水平升高，在透析患者中非常普遍。然而，其在持续性非卧床腹膜透析（CAPD）患者中的预测能力尚不清楚。
方法
纳入了 158 例中位 dp-ucMGP 水平为 1093（752，1485）pmol/L 的 CAPD 患者。在随访期间记录了患者的结局，包括全因死亡率和心血管事件（CVE）。使用 Kaplan-Meier 法绘制生存曲线，Cox 回归模型分析 dp-ucMGP 对结局的影响。
结果
中位随访 31.4±13.1 个月（范围：3.8-48.0 个月）期间，共有 59 例死亡和 82 例新发 CVE。Kaplan-Meier 分析显示，dp-ucMGP 水平较高（≥1093 pmol/L）的患者死亡（P=0.005）和 CVE（P<0.001）的风险均增加。多变量 Cox 回归证实，较高的 dp-ucMGP 水平增加了死亡率风险[危险比（HR），1.763；95%可信区间（CI）1.045-3.291]和 CVE（HR，1.846；95% CI 1.074-3.172）。血清 dp-ucMGP 每增加 100 pmol/L，死亡率和 CVE 的校正 HR 分别为 1.054（95% CI 1.008-1.106）和 1.034（95% CI 1.012-1.089）。
结论
维生素 K 缺乏症，表现为 dp-ucMGP 水平升高，与 CAPD 患者的死亡率和 CVE 独立相关。
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