目的 探讨血清总胆红素与白蛋白比值(total bilirubin to albumin,TBAR)对糖尿病腹膜透析患者心血管疾病死亡的预测效能。 方法 本研究为单中心回顾性研究，分析2013年1月—2021年9月在北部战区总医院行腹膜透析置管术的糖尿病患者的临床数据，利用限制性立方样条图(restricted cubic spline,RCS)确定TBAR的临界值；根据TBAR的临界值将患者分为低TBAR组和高TBAR组，Kaplan-Meier方法比较总生存率；多因素COX回归比例风险模型分析影响心血管疾病死亡的危险因素。 结果 共纳入腹膜透析合并糖尿病患者203例，RCS显示TBAR预测心血管疾病死亡的临界值是0.142。以0.142为临界值将研究对象分为低TBAR组(n=103)和高TBAR组(n=100)。相对低TBAR组，高TBAR组有更高的钙(Z=-1.996,P=0.046)、总胆红素(Z=-11.202,P＜0.001)，更低的血清肌酐(Z=-2.015,P=0.044)、磷(Z= -3.525,P＜0.001)和血小板(t=2.924,P=0.004)。高TBAR组的总生存率为12.6%，低TBAR组的总生存率为75.20%，Kaplan-Meier分析显示高TBAR组的总生存率低于低TBAR组(Log-rank χ2=8.616，P=0.003)。校正混杂因素后，多因素COX回归分析结果显示TBAR(HR=2.131，95% CI：1.102～4.121，P=0.025)、体质量指数(HR=0.859，95% CI：0.781～0.944，P=0.002)、血清肌酐(HR=0.998，95% CI：0.7996～1.000，P =0.017)是糖尿病腹膜透析患者心血管疾病死亡的危险因素。 结论 TBAR可作为一种评估患者预后的简易指标，较高的TBAR(＞0.142)是糖尿病腹膜透析患者心血管疾病死亡的独立危险因素。
Objective To explore the predictive value of total bilirubin to albumin ratio (TBAR) on cardiovascular disease morality in peritoneal dialysis (PD) patients with diabetes mellitus. Methods This study was a single center and retrospective study aiming to analyze the clinical data of diabetes mellitus patients undergoing PD catheterization in the Northern Theater Command General Hospital from January 2013 to September 2021. The restricted cubic spline (RCS) was used to determine the cutoff value of TBAR. Patients were divided into low TBAR and high TBAR groups according to the cutoff value of TBAR. Kaplan-Meier method was used to compare the overall survival rate, and multivariate Cox regression proportional hazards model was used to analyze the risk factors affecting the cardiovascular disease mortality. Results A total of 203 PD patients with diabetes mellitus were included in this study. RCS showed that the cutoff value of TBAR predicting cardiovascular disease morality was 0.142. The study subjects were then divided into low TBAR group (n=103) and high TBAR group (n=100). The high TBAR group had higher calcium (Z=-1.996, P=0.046) and total bilirubin (Z=-11.202, P＜0.001), and lower serum creatinine (Z=-2.015, P=0.044), phosphorus (Z=-3.525, P＜0.001) and platelet (t=2.924, P=0.004) as compared with those in the low TBAR group. Kaplan-Meier analysis showed that the survival rate was 12.60% in the high TBAR group and was 75.20% in the low TBAR group (Log rank, χ2=8.616, P=0.003). After adjusting for confounding factors, multivariate cox regression analysis showed that TBAR (HR=2.131, 95% CI：1.102～4.121, P=0.025), body mass index (HR=0.859, 95% CI：0.781～0.944, P=0.002), and serum creatinine (HR=0.998, 95% CI：0.7996～1.000, P=0.017) were the risk factors for cardiovascular disease morality in PD patients with diabetes mellitus. Conclusion TBAR can be used as a simple indicator to evaluate prognosis of the patients. TBAR higher than 0.142 is an independent risk factor for cardiovascular disease morality in PD patients with diabetes mellitus.
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