目的 探讨血镁与维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡的关系。 方法 回顾2018年1月—2023年12月北京民航总医院血液透析中心MHD患者的一般情况、生化指标及预后等。使用Kaplan-Meier绘制生存曲线，Log-rank检验比较分组间的生存率差异，用COX回归模型分析血镁与MHD患者全因死亡的关系。 结果 共纳入415例患者，其中女性156例(37.6%)，平均年龄(65.64±13.46)岁，中位透析龄69.0(33.0，129.0)个月，观察时间48.0(27.0,69.0)月，全因死亡156例。Kaplan-Meier曲线分析显示低镁组(≤1.04 mmol/L)的生存率低于高镁组(＞1.04 mmol/L)(Log-rank χ2=6.767，P=0.009)。单因素COX回归分析显示血镁是MHD患者全因死亡的保护因素(HR=0.903，95% CI：0.823～0.991，P=0.032)；多因素COX回归分析显示血镁对MHD患者全因死亡不具有独立保护作用(HR=0.952，95% CI：0.964～1.019，P=0.120)，白蛋白(HR=0.793，95% CI：0.725～0.868，P＜0.001)为MHD患者全因死亡的独立保护因素，高龄(HR=1.028，95% CI：1.012～1.045，P=0.001)、合并糖尿病(HR=1.249，95% CI：1.109～1.792，P=0.022)、合并心脑血管病(HR=1.654，95% CI：1.105～2.476，P=0.015)的患者死亡风险更高。Kaplan-Meier曲线分析显示双阴组(血镁＞1.04 mmol/L且白蛋白≥38 g/L)、单阳组(血镁≤1.04 mmol/L或白蛋白＜38 g/L)、双阳组(血镁≤1.04 mmol/L且白蛋白＜38 g/L)生存率依次降低(Log-rank χ2=48.746，P＜0.001)。多因素COX回归分析显示相较于单阳组，双阳组死亡风险更高(HR=1.150，95% CI：1.089～1.683，P=0.046)，双阴组死亡风险降低(HR=0.537，95% CI：0.316～0.912， P=0.021)。 结论 低血镁虽不是MHD患者全因死亡的独立危险因素，但合并低镁血症增加MHD患者低白蛋白时的全因死亡风险。
Objective To explore the relationship between serum magnesium (Mg) and all-cause death in maintenance hemodialysis (MHD) patients. Methods We reviewed the general condition, biochemical indexes and prognosis of MHD patients treated in the Hemodialysis Center of Beijing Civil Aviation General Hospital from January 2018 to December 2023. Results A total of 415 patients were enrolled, including 156 females (37.6%), with a mean age of 65.64±13.46 years and a median dialysis age of 69.0 (33.0, 129.0) months. The observation period was 48.0 (27.0, 69.0) months, during which a total of 156 died. Kaplan-Meier curve analysis revealed a significantly lower survival rate in the low Mg group (≤1.04mmol/L) than in the high Mg group (＞1.04mmol/L) (Log-rank, χ2=6.767, P=0.009). Univariate Cox regression analysis revealed that serum magnesium was a protective effect on all-cause death in MHD patients (HR=0.903, 95% CI: 0.823～0.991, P=0.032). However, multivariate regression analysis showed that serum magnesium had no independent protective effect on all-cause death in MHD patients (HR=0.952, 95% CI: 0.964～1.019, P=0.120); albumin (HR=0.793, 95% CI: 0.725～0.868, P＜0.001) was identified as an independent protective factor, while advanced age (HR=1.028, 95% CI:1.012～1.045, P=0.001), diabetes mellitus (HR=1.249, 95% CI: 1.109～1.792, P=0.022), and cardiovascular and cerebrovascular disease (HR=1.654, 95% CI: 1.105～2.476, P=0.015) were associated with a higher risk of mortality. Kaplan-Meier curve analysis revealed that the double negative group (Mg＞1.04mmol/L and albumin≥38g/L), single positive group (Mg ≤1.04mmol/L or albumin ＜38g/L) and the double positive group (Mg ≤1.04mmol/L and albumin＜38g/L) showed a successively decreased survival rate (Log-rank, χ2=48.746, P＜0.001). Compared with the single positive group, the double positive group had a higher risk of death (HR=1.150, 95% CI: 1.089～1.683, P=0.046), and the double negative group had a significantly lower risk of death (HR=0.537, 95% CI: 0.316～0.912, P=0.021). Conclusion Hypomagnesemia is not an independent risk factor for all-cause death in MHD patients, but hypomagnesemia combined with hypoalbuminemia increase the risk of all-cause death in MHD patients.
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