在血液透析维持的患者中血铅浓度与死亡率的相关性

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Am J Med. 2011 Apr;124(4):350-8.
Association of blood lead levels with mortality in patients on maintenance hemodialysis.
Lin JL, Lin-Tan DT, Hsu CW, Yen TH, Chen KH, Hsu HH, Ho TC, Hsu KH.
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Lin-Kou Medical Center, Taoyuan, Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
Abstract
BACKGROUND: The association between blood lead levels and mortality in patients on maintenance hemodialysis remains unclear.
METHODS: A cross-sectional and 18-month prospective study included 927 patients on maintenance hemodialysis. Baseline variables and blood lead levels were measured before hemodialysis and categorized as 3 equal groups: high (>12.64 μg/dL), middle (8.51-12.64 μg/dL), and low (<8.51 μg/dL). Mortality and cause of death were recoded for longitudinal analyses.
RESULTS: At baseline, after related variables were adjusted, logarithmic transformation of blood lead level was negatively related to log ferritin and positively related to the vintage of hemodialysis and the percentage of urban area patients. By the end of the follow-up, 59 patients had died. Kaplan-Meier survival analysis showed that the high blood lead level group had greater mortality than the low blood lead level group (log-rank test, P<.001). After adjustment for potential variables, Cox multivariate analysis demonstrated that by using the low blood lead level as the reference, high blood lead levels were associated with increased hazard ratios (HRs) for all-cause (HR 4.70; 95% confidence interval [CI], 1.92-11.49; P=.003), cardiovascular-cause (HR 9.71; 95% CI, 2.11-23.26; P=.005), and infection-cause (HR 5.35; 95% CI, 1.38-20.83; P=.046) 18-month mortality in patients on maintenance hemodialysis. Moreover, there was a significant trend (P=.032) of HRs for all-cause mortality among the 3 study groups.
CONCLUSION: High blood lead level is associated with increased HRs for all-cause, cardiovascular-cause, and infection-cause 18-month mortality in patients on maintenance hemodialysis.

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文摘
背景:进行维持性血液透析患者中血铅水平与死亡率之间的相关性仍不清楚。
方法:针对927名维持性血液透析患者开展一项横断面调查和为期18个月前瞻性研究。血液透析前测量基线变量和血铅浓度,共分为3组:高(> 12.64μg / dL),中(8.51-12.64μg / dL),低(< 8.51μg / dL)。死亡率和死亡原因采用纵向调查。
结果:经过相关的变量的调整，对数变换的血铅水平和log铁蛋白呈负相关，和血透患者透析年份、市区患者的比例呈正相关。到最后的随访中,59例已经死亡。Kaplan-Meier生存分析表明,高血铅水平组比低血铅水平组有更高的死亡率(log-rank检验,P < . 001)。调整了潜在的变量,cox多变量分析显示,采用低血铅水平为参考、高血铅水平增加18月维持血透患者死亡率的风险比(HRs),分别为所有原因(HR 4.70;95%可信区间[CI],1.92-11.49;P = 0.003),心血管原因(HR9.71;95%可信区间,2.11-23.26;P = . 005),感染原因(HR5.35;95%可信区间,1.38-20.83;P = .046 ）。而且,研究中的3个组在所有原因死亡率上均有明显统计学差异(P = .032)
结论：高血铅增加了维持血透患者与总原因、心血管原因、感染原因相关的18月死亡率的风险

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