维持性血液透析患者捏力与心血管事件及全因死亡率的相关性。
Associations between pinch strength, cardiovascular events and all-cause mortality in patients undergoing maintenance hemodialysis.
机构信息
Clinical Collage of Medicine, Guizhou Medical University, Guiyang, China.
Department of Nephrology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
出版信息
BMC Nephrol. 2024 May 2;25(1):150. doi: 10.1186/s12882-024-03587-x.
BACKGROUND AND AIMS
Patients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch strength (PS) and the prognosis of these patients remains unknown. Consequently, this study aimed to comprehensively assess the influence of PS and handgrip strength (HGS) on both survival and cardiovascular events (CVE) in patients undergoing MHD.
METHODS
Data were gathered from patients undergoing MHD at the Hemodialysis Center of Guangzhou Red Cross Hospital in March 2021. We performed a retrospective follow-up spanning 24 months, with death serving as the primary endpoint for observation and CVE as the secondary endpoint. Multifactorial Cox regression analysis, Kaplan-Meier survival curves, trend tests, and restricted cubic spline were applied to explore the association.
RESULTS
During a 24-month follow-up, data were collected from 140 patients undergoing MHD with an average age of 66.71 ± 12.61 years. Among them, 52 (37.14%) experienced mortality, whereas 36 (40.00%) had CVE without baseline CVD. Kaplan-Meier survival curves demonstrated better survival rates and reduced CVE risk for patients in the second, third, and fourth quartiles compared with those in the first quartile for PS. Adjusted analyses in different models revealed higher PS levels were independently associated with all-cause mortality (major model, model 4, HR, 0.78; 95% CI, 0.64-0.95) but not with CVE risk (unadjusted HR, 0.90; 95% CI, 0.77-1.05). Compared with lower quartile PS levels, higher PS levels significantly reduced all-cause mortality (HR, 0.31; 95% CI, 0.10-1.02), and this trend remained consistent (P for trend = 0.021). Finally, the restricted cubic spline method using different models showed a linear relationship between PS and all-cause mortality (P > 0.05), when PS exceeded 4.99 kg, the all-cause mortality of MHD patients significantly decreased.
CONCLUSIONS
PS was independently associated with all-cause mortality but not with CVE in patients undergoing MHD.
背景和目的
接受维持性血液透析（MHD）的患者死亡率和心血管疾病（CVD）风险增加；然而，握力（PS）与这些患者预后之间的潜在联系尚不清楚。因此，本研究旨在全面评估 PS 和手握力（HGS）对 MHD 患者生存和心血管事件（CVE）的影响。
方法
本研究的数据来自 2021 年 3 月在广州红十字会医院血液透析中心接受 MHD 的患者。我们进行了为期 24 个月的回顾性随访，以死亡为主要观察终点，以 CVE 为次要终点。采用多因素 Cox 回归分析、Kaplan-Meier 生存曲线、趋势检验和限制性立方样条分析来探讨相关性。
结果
在 24 个月的随访期间，共收集了 140 名接受 MHD 的患者的数据，平均年龄为 66.71±12.61 岁。其中，52 名（37.14%）患者死亡，36 名（40.00%）患者无基线 CVD 发生 CVE。Kaplan-Meier 生存曲线显示，与 PS 第一四分位相比，PS 处于第二、三、四分位的患者生存率更高，CVE 风险更低。在不同模型的调整分析中，较高的 PS 水平与全因死亡率独立相关（主要模型，模型 4，HR，0.78；95%CI，0.64-0.95），但与 CVE 风险无关（未调整 HR，0.90；95%CI，0.77-1.05）。与较低 PS 四分位相比，较高 PS 水平显著降低了全因死亡率（HR，0.31；95%CI，0.10-1.02），且这种趋势一致（趋势 P 值=0.021）。最后，使用不同模型的限制性立方样条方法显示 PS 与全因死亡率之间存在线性关系（P>0.05），当 PS 超过 4.99 kg 时，MHD 患者的全因死亡率显著降低。
结论
PS 与 MHD 患者的全因死亡率独立相关，但与 CVE 无关。
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