探讨维持性血液透析患者血镁水平的影响因素及其与死亡率的相关性。

选取2020年1月1日于大连市中心医院进行维持性血液透析(MHD)治疗的符合入组条件的患者，收集患者的一般信息、血镁水平、其它实验室检查结果。共纳入757例患者，其中男性452例(59.7%)，女性305例(40.3%)，平均年龄59.77±13.82岁，中位透析龄46(18.5，91.0)个月。血镁平均水平1.09±0.15 mmol/L。根据基线血镁水平按四分位数将患者分为4组：组1(血镁<1.0 mmol/L，n＝178)，组2(1.0≤血镁<1.08 mmol/L，n＝203)，组3(1.08≤血镁<1.17 mmol/L，n＝171)，组4(血镁≥1.17 mmol/L，n＝205)。随访至2020年12月31日，终点事件为全因死亡。采用Kaplan-Meier软件进行生存分析，Log-rank检验方法比较生存率；相关性分析使用Pearson或Spearman软件；多元线性逐步回归方法分析血镁的影响因素。采用SPSS24.0进行统计学分析，P<0.05为有统计学意义。

4个组患者的年龄、透析龄、血压无统计学差异，而血红蛋白、白蛋白、尿素、肌酐、血钙、血磷、总胆固醇、铁蛋白、C反应蛋白(CRP)、Kt/V有统计学差异(P<0.05)。多元回归分析显示：血红蛋白、白蛋白、尿素、血钙、血磷、Kt/V与血镁正相关，全段甲状旁腺激素(iPTH)、铁蛋白、CRP与血镁负相关(P<0.05)。Log-rank检验结果显示4组患者生存率有统计学差异(χ²＝13.113，P＝0.004) ，血镁低组患者死亡率明显高于血镁高组。多因素Cox回归分析显示血镁水平是影响MHD患者死亡率的独立危险因素。

应关注维持性血液透析患者的血镁水平，血镁低组患者死亡率明显高于血镁高组，血镁是影响MHD患者死亡率的独立危险因素。

To investigate the serum magnesium level in its influencing factors and correlation with mortality of maintenance hemodialysis (MHD) patients.

On January 1, 2020 in Dalian Municipal Central Hospital, patients undergoing MHD and being eligible for entry were selected, whose general information, serum magnesium level, and other laboratory data were collected. A total of 757 patients were enrolled, including 452 males (59.7%) and 305 females (40.3%), with an average age of 59.77±13.82 years as well as a dialysis median time of 46 (18.5, 91.0) months. The average serum magnesium level was 1.09±0.15 mmol/L. The patients were divided into four groups according to the quartile of the serum magnesium level, including group 1 (serum magnesium <1.0 mmol/L, n=178), group 2 (1.0≤serum magnesium <1.08 mmol/L, n=203), group 3 (1.08≤ serum magnesium <1.17 mmol/L, n=171), and group 4 (serum magnesium ≥ 1.17 mmol/L, n=205). The follow-up was given until December 31, 2020, with the all-cause death as the end-point event. Kaplan-Meier software was used for survival analysis, and log-rank test method was used to compare the survival rate. Pearson or Spearman software was used for correlation analysis, while multiple linear stepwise regression method was applied to analyze the influencing factors of serum magnesium level. SPSS 24.0 method was used for statistical analysis, with P<0.05 as being of statistical significance.

There was no statistical difference in the age, dialysis age, and blood pressure among the four groups of patients, while there were statistical differences in blood hemoglobin, albumin, urea, creatinine, calcium, phosphorus, total cholesterol, ferritin, C-reactive protein (CRP), and Kt/V (P<0.05). Multiple regression analysis showed that blood hemoglobin, albumin, urea, calcium, phosphorus, and Kt/V were positively correlated with the serum magnesium level, while intact parathyroid hormone (iPTH), ferritin, and CRP were negatively correlated with the serum magnesium level (P<0.05). Log-rank test showed that the survival rates among the four groups were statistically different (χ²=13.113, P=0.004). The mortality of patients in the group with lower serum magnesium level was significantly higher than that of patients in the group with higher serum magnesium level. Multivariate Cox regression analysis showed that serum magnesium level was an independent risk factor for the mortality of MHD patients.

Attention should be paid to the serum magnesium level of MHD patients. The mortality of MHD patients was significantly higher in the group with lower serum magnesium level than in the group with higher serum magnesium level. Serum magnesium was an independent risk factor that could affect the mortality of MHD patients.