低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值升高与腹膜透析患者死亡率的预测研究。
The predictive study of the relation between elevated low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and mortality in peritoneal dialysis.
机构信息
Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 58th, Zhongshan Road II, Guangzhou, 510080, People's Republic of China.
Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, 510080, People's Republic of China.
出版信息
Lipids Health Dis. 2020 Mar 21;19(1):51. doi: 10.1186/s12944-020-01240-8.
BACKGROUND
The low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio constitutes a strong risk predictor of cardiovascular events. However, the association between this ratio and cardiovascular death in peritoneal dialysis (PD) patients is uncertain. The study aimed to investigate whether a high LDL-C/HDL-C ratio could predict both cardiovascular and all-cause mortalities in patients on PD.
METHODS
A total of 1616 incident patients on PD included from January 1, 2006 to December 31, 2013 were followed up with until 31 December 2018 in this single-center prospective cohort study. Participants were divided into three categories according to LDL-C/HDL-C ratio tertile. The primary endpoint was cardiovascular mortality; the secondary endpoint was all-cause mortality.
RESULTS
The mean age of the study cohort was 47.5 years and the mean body mass index (BMI) was 21.6 kg/m. During a median follow-up period of 47.6 months, 492 patients died, including 246 (50.0%) due to cardiovascular disease (CVD). A multivariate analysis revealed that the highest LDL-C/HDL-C ratio tertile was significantly associated with increased CVD mortality [hazard ratio (HR): 1.69, 95% CI: 1.24-2.29; P = 0.001] and all-cause mortality (HR: 1.46, 95% CI: 1.18-1.81; P = 0.001) relative to the lowest tertile. After adjusting for covariates, the HRs of cardiovascular and all-cause mortalities were 1.84 (95% CI: 1.25-2.71; P = 0.002) and 1.35 (95% CI: 1.03-1.77; P = 0.032). Subgroup analysis showed that the risk of CVD death rose with a higher LDL-C/HDL-C ratio among PD patients who were female, younger than 65 years old, without being malnourished (BMI ≥ 18.5 kg/m or albumin ≥35 g/L), and with a history of diabetes or CVD, respectively.
CONCLUSIONS
A high LDL-C/HDL-C ratio is an independent risk factor for both cardiovascular and all-cause mortalities among PD patients.
背景
低密度脂蛋白胆固醇与高密度脂蛋白胆固醇（LDL-C/HDL-C）比值是心血管事件的强有力预测指标。然而，该比值与腹膜透析（PD）患者心血管死亡之间的关联尚不确定。本研究旨在探讨高 LDL-C/HDL-C 比值是否可预测 PD 患者的心血管死亡和全因死亡。
方法
这项单中心前瞻性队列研究纳入了 2006 年 1 月 1 日至 2013 年 12 月 31 日期间开始接受 PD 治疗的 1616 例患者，随访至 2018 年 12 月 31 日。根据 LDL-C/HDL-C 比值三分位将参与者分为三组。主要终点为心血管死亡；次要终点为全因死亡。
结果
研究队列的平均年龄为 47.5 岁，平均体重指数（BMI）为 21.6kg/m。在中位随访 47.6 个月期间，492 例患者死亡，其中 246 例（50.0%）死于心血管疾病（CVD）。多变量分析显示，最高 LDL-C/HDL-C 比值三分位组与 CVD 死亡率增加显著相关[风险比（HR）：1.69，95%置信区间：1.24-2.29；P=0.001]和全因死亡率（HR：1.46，95%置信区间：1.18-1.81；P=0.001）与最低三分位组相比。在校正了混杂因素后，心血管死亡和全因死亡的 HR 分别为 1.84（95%置信区间：1.25-2.71；P=0.002）和 1.35（95%置信区间：1.03-1.77；P=0.032）。亚组分析显示，在女性、年龄<65 岁、无营养不良（BMI≥18.5kg/m 或白蛋白≥35g/L）、有糖尿病或 CVD 病史的 PD 患者中，随着 LDL-C/HDL-C 比值的升高，CVD 死亡风险也会增加。
结论
高 LDL-C/HDL-C 比值是 PD 患者心血管死亡和全因死亡的独立危险因素。
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