目的 探究维持性血液透析(maintenance hemodialysis,MHD)患者血镁水平与全因死亡、心脑血管死亡及非心脑血管死亡的相关性。 方法 纳入2014年1月1日～2020年1月1日在重庆医科大学附属第二医院行MHD的患者。收集透析前基线数据及开始透析后每3个月的临床随访数据进行分析。按平均血镁值四分位数进行分组：Q1组(血镁≤0.98mmol/L)、Q2组(0.98＜血镁≤1.06mmol/L)、Q3组(1.06＜血镁≤1.13mmol/L)、Q4组(血镁＞1.13mmol/L)；结合限制性立方样条模型将Q2、Q3组合并为Qi组(0.98＜血镁≤1.13mmol/L)，Q1、Q4组合并为Qo组。Kaplan-Meier法用于生存分析，COX风险回归模型用于分析死亡率的影响因素。 结果 共纳入182例MHD患者，其中Q1组46例，Q2组45例，Q3组46例，Q4组45例。Kaplan-Meier生存分析提示：4组间总体的生存率有统计学差异(Log-rank χ2=9.024，P=0.029)。Qi组与Qo组总体及非心脑血管的生存率有统计学差异(Log-rank χ2=8.892，P=0.003；Log-rank χ2=7.385，P=0.007)。COX回归模型结果发现：以Qi组为对照组，Qo组患者的全因死亡风险及非心脑血管死亡风险更高，校正混杂因素后Qo组较Qi组全因死亡风险增加88.7%(HR=1.887,95%CI：1.012～3.519,P=0.046)。 结论 本研究发现血镁水平与MHD患者全因死亡率相关，当0.98＜血镁≤1.13mmol/L时全因死亡率更低。
Objective To explore the correlation between serum magnesium level and all-cause mortality, cardio-cerebrovascular mortality and non-cardio-cerebrovascular mortality in maintenance hemodialysis (MHD) patients. Methods Patients who underwent MHD in The Second Affiliated Hospital of Chongqing Medical University from January 1, 2014 to January 1, 2020 were enrolled in this study. The baseline data before dialysis and clinical follow-up data every 3 months after dialysis were collected and analyzed. The patients were grouped by the quartile of average serum magnesium value: Q1 (Mg≤0.98mmol/L), Q2 (Mg>0.98≤1.06mmol/L), Q3 (Mg >1.06 ≤1.13mmol/L), Q4 (Mg >1.13mmol/L). Combined with the Restricted Cubic Spline model, Q2 and Q3 were combined into Qi group (Mg >0.98 ≤1.13mmol/L), and Q1 and Q4 were combined into Qo group. Kaplan-Meier method was used to survival analysis. COX regression model was used to analyze the influencing factors for mortality. Results A total of 182 MHD patients were enrolled, including 46 patients in group Q1, 45 patients in group Q2, 46 patients in group Q3, and 45 patients in group Q4. Kaplan-Meier survival analysis showed that there was a statistical difference in total survival rate among the four groups (Log-rank χ2=9.024, P=0.029). There were statistical differences in total survival rate and non-cardio-cerebrovascular survival rate between groups Qi and Qo (Log-rank χ2=8.892, P=0.003; Log-rank χ2=7.385, P=0.007). Cox regression model found that the risk of all-cause mortality and non-cardio-cerebrovascular mortality increased in patients in group Qo when patients in group Qi were used as the controls. After adjusting for confounders, the risk of all-cause mortality in the Qo group increased by 88.7%, as compared with that in the Qi group (HR=1.887, 95% CI： 1.012～3.519, P=0.046). Conclusions This study found that serum magnesium level was associated with all-cause mortality in MHD patients. Our results also suggest that the all-cause mortality is lower in patients with the serum magnesium between 0.98 and 1.13mmol/L.
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