血清镁对老年男性急性肾损伤患者短期预后的影响

Impact of serum magnesium level on short-term prognosis in old male patients with acute kidney injury

摘要:

目的 对老年急性肾损伤(AKI)患者进行随访观察,探讨AKI患者血清镁紊乱发生情况及血清镁水平对老年AKI患者短期生存的影响。方法 选择2007年1月至2015年12月就诊于解放军总医院老年病房≥75岁的住院男性AKI患者为研究对象。根据AKI后28 d时和60 d时患者的生存情况,将患者病历资料分为死亡组和存活组进行分析。以血清镁<0.7 mmol/L为低镁血症,>1.1 mmol/L为高镁血症。采用SPSS 17.0软件进行统计分析。Kaplan-Meier乘积法估计生存曲线,并通过对数秩检验进行比较,多因素Cox回归模型分析血清镁对老年患者短期生存的影响。结果 623例老年男性AKI患者,中位年龄87(84,91)岁。正常血镁者473例(75.9%),低镁血症患者 72例(11.6%),高镁血症患者78例(12.5%)。发生AKI后28 d内死亡160例,60 d内共死亡194例。采用Kaplan-Meier生存曲线比较显示高镁血症患者28 d生存状况明显较差(log-rank检验:P=0.001)。多因素Cox回归分析显示AKI诊断时间(HR=0.865,5%CI 0.799~0.937; P<0.001)、平均动脉压(HR=0.970,5%CI 0.958~0.981; P<0.001)、血清前白蛋白(HR=0.924,5%CI 0.894~0.955; P<0.001)、少尿(HR=2.261,5%CI 1.424~3.590; P=0.001)、机械通气(HR=1.492, 95%CI 1.047~2.124; P=0.027)、血尿素氮(HR=1.037, 95%CI 1.025~1.049; P<0.001)、血镁水平(HR=2.512, 95%CI 1.243~5.076; P=0.010)、AKI分期(2期:HR=3.709,5%CI 1.926~7.141, P<0.001；3期:HR=5.660, 95%CI 2.990~10.717, P<0.001)是老年AKI患者28 d生存的影响因素。血清镁对患者29~60 d的生存影响无统计学意义。结论 老年AKI患者镁离子紊乱发生率高达24.1%(150/623),高血镁与老年男性AKI患者28 d病死率密切相关,监测及适当纠正血镁紊乱可能会延长其生存时间。

Abstract:

Objective To investigate the magnesium disorder and determine the effect of serum magnesium level on short-term prognosis in the old patients with acute kidney injury (AKI). Methods The old male patients(≥75 years old) with AKI admitted in the Geriatric Department of our hospital between January 2007 and December 2015 were enrolled in this study. According to their outcomes in 28 d and from 29 to 60 d after AKI respectively, they were also divided into survival and death groups. Hypomagnesemia is defined as serum magnesium <0.7 mmol/L, and hypermagnesemia as >1.1 mmol/L. SPSS statistics 17.0 was used to perform the statistical analysis. The survival curves were estimated by Kaplan-Meier (product-limit) Estimator, and compared by Mantel (log-rank) test. Multivariate Cox proportional regression model was used to analyze the effect of serum magnesium on short-term survival in elderly patients. Results There were 623 old male AKI patients included, at a median age of 87(84,91) years, including 473 patients (75.9%) in the normal magnesium, 72(11.6%) in hypomagnesemia, and 78(12.5%) in hypermagnesemia. One hundred and sixty patients (24.5%) died within 28 d after AKI, and 194 cases (29.8%) died within 60 d. The Kaplan-Meier survival curve showed the high magnesium patients had worse 28-day survival (log rank P=0.001). Multivariate Cox analysis revealed that time of AKI diagnosis (HR=0.865,5%CI 0.799-0.937; P<0.001), mean aortic pressure(HR=0.970, 95%CI 0.958-0.981; P<0.001), serum prealbumin level(HR=0.924,5%CI 0.894-0.955; P<0.001), oliguria (HR=2.261, 95%CI 1.424-3.590; P=0.001), mechanical ventilation(HR=1.492,5%CI 1.047-2.124; P=0.027), blood urea nitrogen level (HR=1.037, 95%CI 1.025-1.049; P<0.001), magnesium level (HR=2.512,5%CI 1.243-5.076; P=0.010) and AKI stages (stage 2:HR=3.709, 95%CI 1.926-7.141, P<0.001; stage 3:HR=5.660,5%CI 2.990-10.717, P<0.001) were the influencing factors for 28-day mortality. However, no significant difference was found in serum magnesium level for 29 to 60-day mortality. Conclusion The incidence of magnesium disorder is up to 24.1% in old male AKI patients. High serum magnesium level is associated with 28-day mortality, so more intensive monitoring and appropriate correction of serum magnesium level may prolong their survival time.