中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (01): 12-16.doi: 10.3969/j.issn.1671-4091. 2014.01.004

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血红蛋白的变异性和死亡相关

蔡宏,张伟明,严玉澄,陆任华,庞慧华,林星辉,朱铭力,倪兆慧,钱家麒   

  1. 上海交通大学医学院附属仁济医院肾脏内科
  • 收稿日期:2013-08-12 修回日期:2013-09-09 出版日期:2014-01-12 发布日期:2014-01-12
  • 通讯作者: 张伟明 weimingzh1965@163.com E-mail:chcaicai@hotmail.com

Hemoglobin Variability is associated with Mortality in patients on maintenance hemodialysis

  • Received:2013-08-12 Revised:2013-09-09 Online:2014-01-12 Published:2014-01-12

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摘要： [摘要]目的探讨维持性血液透析（MHD）患者血红蛋白变异性和全因死亡之间的关系。方法收集2007年7月至2012年12月上海市透析登记系统中登记的364例上海交通大学医学院附属仁济医院MHD患者一般情况、生化指标以及预后。评估血红蛋白的变异性与全因死亡之间的关系。结果 364例患者平均年龄63.07±13.93岁，平均透析龄76.0(42.25,134.0)月，死亡患者85例占23.4%。MHD死亡患者平均血红蛋白SD和CV较高[分别为19.19±6.31 vs 13.74±5.89和0.172±0.07 vs 0.126±0.056,P均<0.001]，与存活患者相比均有统计学差异。血红蛋白SD大于P75（上四分位数）组，其发生全因死亡的危险显著高于SD小于P25（上四分位数）组患者[OR=5.964,95%CI(2.663~13.357),P<0.001]。校正了年龄、性别、生活方式和生化指标后，两者结果相同[OR=4.961,95%CI(1.959~11.238)，P<0.001]。Kaplan-Meier分析显示血红蛋白SD和CV小于 P25患者其生存率显著低于P75组患者（P均<0.001）。ROC曲线下面积（AUC）显示血红蛋白SD、CV预测MHD患者全因死亡的AUC分别为0.677g/l和0.721(当截断点为10.647和0.1086时，其敏感性为89.4%和85.1%，特异性为67.7%和60.3%)。多因素Logistic回归分析显示血红蛋白CV升高、年龄增加和CRP升高是MHD患者全因死亡独立危险因素。结论 MHD患者血红蛋白的变异性较大患者具有较高死亡危险度，血红蛋白的变异性可能有助于MHD患者全因死亡的预测。

关键词: 维持性血液透析, 血红蛋白, 变异性

Abstract: Objective To determine the relationship between hemoglobin variability and mortality in maintenance hemodialysis (MHD) patients. Methods A total of 364 MHD cases were recruited from Shanghai Renal Registry Network. The relationship between hemoglobin variability and all-cause mortality was assessed. Results In the 364 MHD cases, the average age was 63.07±13.93 years, the dialysis vintage was 76.0 (42.25, 134.0) months, and 85 patients (23%) died. The dead patients had a higher mean hemoglobin SD and CV comparing with the survival patients (19.19±6.31 vs. 13.74±5.89, and 0.172±0.07 vs. 0.126±0.056, respectively, P＜0.001). Risk of all- cause mortality in patients in the upper quartile (P75) of hemoglobin SD was significantly higher than those in the lower quartile (P25) (OR=5.964, 95% CI 2.663～13.357, P＜0.001), even after adjustment for demographic data, lifestyle factors and biochemical markers (OR=4.961, 95% CI 1.959～11.238, P＜0.001). Kaplan-Meier method showed that patients with hemoglobin SD and CV in the upper quartile had a lower survival rate (P＜0.001). ROC-AUC of hemoglobin SD and CV for all-cause mortality were 0.677 and 0.721, respectively (cutoff 10.647g/l and 0.1086, respectively; accuracy 89.4% and 85.1%, respectively; specificity 67.7% and 60.3%, respectively; P＜0.001). Multivariate logistic regression analysis showed that higher hemoglobin CV, older age and higher CRP were the independent risk factors for all-cause mortality. Conclusions The highest hemoglobin SD and CV were independently correlated with all- cause mortality. Hemoglobin variability may have prediction value for mortality in MHD patients.

Key words: maintenance hemodialysis, hemoglobin, variability