目的 调查细胞外液/细胞内液(extracellular fluid/intracellular fluid，ECF/ICF)、老年营养风险指数(geriatric nutritional risk index，GNRI)对维持性血液透析(maintenance hemodialysis，MHD)患者长期生存的联合影响。 方法 回顾性分析2010年10月—2015年10月在台州市中心医院接受MHD且接受过常规生物电阻法身体成分分析的486例患者的病历资料。从病历中采集患者人口学和临床数据以及ECF/ICF，计算GNRI。患者按GNRI中位数[94.53(84.22,99.17)]和ECF/ICF中位数[0.56(0.41,0.87)]分为高GNRI组和低GNRI组、高ECF/ICF组和低ECF/ICF组、高GNRI+低ECF/ICF组(G1)、低GNRI+低ECF/ICF组(G2)、高GNRI+高ECF/ICF组(G3)、低GNRI+高ECF/ICF组(G4)。 结果 多因素线性回归分析发现ECF/ICF与GNRI独立相关(β=−0.247，P=0.001)。G1、G2、G3和G4组7年生存率分别为74.4%、57.6%、38.7%和20.9%(Log rank χ2=28.845，P＜0.001)。多因素COX比例风险回归分析显示：以G1为参照，G2、G3和G4死亡的调整HR分别为8.733(95% CI 3.620～47.715)、16.272(95% CI 6.416～64.333)和20.322(95% CI 11.383～73.261)。在基础模型中单独加入GNRI、单独加入ECF/ICF以及二者结合建立死亡风险模型后的C指数从0.714改善至0.743、0.813和0.831。 结论 ECF/ICF与GNRI独立相关，均为血液透析患者全因死亡率较强的预测因子。GNRI和ECF/ICF相结合可以提高预测死亡结局的能力。建议将二者纳入MHD患者常规评估。
Objective To investigate the relationship between extracellular fluid/intracellular fluid ratio (ECF/ICF) and geriatric nutritional risk index (GNRI) in the elderly, and to determine the predictive value of ECF/ICF combined with GNRI for all-cause mortality in maintenance hemodialysis (MHD) patients. Methods The medical records of 486 MHD patients treated in Taizhou Central Hospital from October 2010 to October 2015 and subjected to routine biologic resistance (BIA) body composition examination were retrospectively analyzed. Their demographic and clinical data and ECF/ICF were retrieved from the medical records, and their GNRI was calculated by a basic formula. Based on the median of GNRI [94.53 (84.22, 99.17)] and the median of ECF/ICF [0.56(0.41, 0.87)], the patients were first divided into high GNRI (≥94.53) group and low GNRI (< median) group, high ECF/ICF group (≥0.56) group and low ECF/ICF (< median) group; four subgroups were further derived: G1, patients with high GNRI and low ECF/ICF; G2, patients with low GNRI and low ECF/ICF; G3, patients with high GNRI and high ECF/ICF; G4, patients with low GNRI and high ECF/ICF. Results Multivariate linear regression showed that ECF/ICF was independently correlated with GNRI (β=-0.247, P=0.001). The 7-year survival rates in G1, G2, G3 and G4 groups were 74.4%, 57.6%, 38.7% and 20.9%, respectively (Log rank: χ2=28.845, P<0.001). Multivariate COX proportional hazard regression showed that the adjusted HR for all-cause mortality in G2, G3 and G4 were 8.73 (95% CI 3.62～47.72), 16.27 (95% CI 6.42～64.33) and 20.32 (95% CI 11.38～73.26) respectively using G1 as a reference. After adding GNRI, ECF/ICF, and the combination of GNRI and ICF into the basic model, the C index of death risk model was improved from 0.714 to 0.743, 0.813, and 0.831. Conclusions ECF/ICF was independently correlated with GNRI, and both of which were the strong predictors for all-cause mortality in MHD patients. The combination of GNRI and ECF/ICF improved the ability to predict mortality outcomes. We therefore recommend that GNRI and ECF/ICF should be included in routine evaluation of MHD patients.
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