【摘要】目的研究维持性血液透析(maintenance hemodialysis，MHD)患者血清镁离子水平与心脑血管事件及全因死亡率的关系。方法纳入在皖南医学院弋矶山医院行MHD治疗的患者，从2017年6月1日开始随访至2020 年12 月30 日收集临床数据，按照测定血镁(Mg)三分位数分为低Mg(≤0.98mmol/L)组、中度Mg(0.98～1.10mmol/L)组和高Mg(≥1.10mmol/L)组，比较3 组临床数据的差异；COX 回归分析死亡的影响因素。结果384 例MHD 患者，低Mg 组135 例，中度Mg 组120 例，高Mg 组129 例。心脑血管疾病及心脑血管死亡3 组间存在显著差异(Z=6.506、P=0.039；Z=9.348、P=0.009)；Log-Rank 检验显示3 组心脑血管死亡率差异明显(Log-rank c2=8.313，P=0.016)，单因素COX 回归分析显示Mg、高Mg 血症(Mg＞0.98mmol/L)是MHD 患者心脑血管死亡的保护因素(HR= 0.060，95% CI:0.005～0.703，P=0.025；HR=0.421，95%CI:0.220～0.807，P=0.009)，但校正多项混杂因素后COX 回归显示低Mg 并非心脑血管死亡的独立危险因素(HR=1.066，95%CI:0.339～3.352，P=0.912)。结论低Mg 组MHD 患者心脑血管疾病死亡率高于其余2组，但低Mg 可能并非是独立危险因素。
【Abstract】Objective To investigate the association between serum magnesium and cardiovascular and cerebrovascular events and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods The clinical data of patients who underwent hMHD in Yijishan Hospital of Wannan Medical College from June 1, 2017 to December 30, 2020 were collected. Patients were divided into 3 groups according to the tertiles of mean serum magnesium. The differences of clinical data were compared among the three groups. COX regression was used to determine the factors influencing the mortality in MHD patients. Results In the 384 MHD
patients, 135 patients in the low magnesium group (Mg≤0.98 mmol/L), 120 patients in the normal magnesium group (Mg 0.98～1.1 mmol/L)，129 patients in the high magnesium group (Mg≥1.1 mmol/L). The prevalence of cardiovascular and cerebrovascular diseases and the proportion of cardiovascular and cerebrovascular mortality were significantly different among the three groups (Z=6.506, P=0.039; Z=9.348 P=0.009); Log-Rank test showed that cardiovascular and cerebrovascular mortality was statistically significant (Log-rank c2=8.313, P=0.016) among the three groups. The univariate COX regression analysis showed that serum magnesium and hypermagnesemia (Mg>0.98mmol/L) were the protective factors for cardiovascular and cerebrovascular mortality
(HR=0.060, 95% CI: 0.005～0.703, P=0.025; HR=0.421, 95% CI: 0.220~0.807, P=0.009), but the COX regression after adjusting for many mixed factors showed that hypomagnesemia is not an independent risk factor for cardiovascular and cerebrovascular mortality (HR=1.066，95% CI: 0.339～3.352，P=0.912). Conclusion The cardiovascular and cerebrovascular mortality in MHD patients with hypomagnesemia is higher than the other two groups, but it may not be an independent risk factor.
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