中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (06): 428-432.doi: 10.3969/j.issn.1671-4091.2014.06.003

• 临床研究 • 上一篇    下一篇

腹膜透析患者血红蛋白波动与其心血管预后

陈雅,倪兆慧,顾乐怡,方炜,曹励欧,钱家麒   

  1. 上海交通大学附属仁济医院
  • 收稿日期:2014-04-02 修回日期:2014-04-28 出版日期:2014-06-12 发布日期:2014-06-12
  • 通讯作者: 倪兆慧 profnizh@126.com E-mail:profnizhao@126.com
  • 基金资助:

    十二五”国家科技支撑计划课题(2011BAI10B08)；国家自然科学基金面上项目(81370794)

The relationship between hemoglobin variation and cardiovascular prognosis in peritoneal dialysis patients

  • Received:2014-04-02 Revised:2014-04-28 Online:2014-06-12 Published:2014-06-12

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摘要： 目的：了解腹透患者血红蛋白波动与其心血管预后关系。方法：搜集2006年5月1日至2011年9月1日在上海仁济医院开始透析并持续腹透3个月或以上患者的基线及随访期间的临床及实验室检查资料，随访截止日期为2011年12月1日。按血红蛋白波动绝对值、血红蛋白波动趋势及促红素反应性对腹透患者血红蛋白波动进行分组并进行统计学分析。结果：398名患者中，最终333名纳入分析。透析开始3个月时血红蛋白升高<10g/l新患CVD人数的百分比（27.2%vs12.2%，P<0.05）及CVD事件人时发病率显著高于≥10g/l一组（1/76.2 vs 1/120.1次/病人月）。在血红蛋白波动趋势分组中，透析3个月血红蛋白始终较高的患者组（即H-H组）既往患有CVD疾病再发CVD事件的人数百分比显著高于其他三组。在促红素反应性对腹透患者生存的影响中，促红素反应性<0.01g/l/100u的患者CVD事件人时发病率(1 /59.2次/病人月)明显高于其他组。结论：腹透患者血红蛋白波动影响其心血管预后。研究提示对于既往无CVD合并症的患者，应及时纠正贫血，而对于既往有CVD患者，血红蛋白水平不宜长期维持在高水平。在临床中需密切注意促红素低反应的患者可能更容易出现CVD事件。此结论推广还需进一步证实。

关键词: 血红蛋白波动, 心血管事件, 腹膜透析

Abstract: Objective To understand the effect of hemoglobin (Hb) fluctuation on cardiovascular prognosis in peritoneal dialysis (PD) patients. Methods We recruited clinical and laboratory data of the PD patients treated in Division of Nephrology, Renji Hospital for more than 3 months in the period from May 1st, 2006 to Sept. 1st, 2011. They were followed up until Dec. 1st, 2011. The absolute value of Hb variation, the trend of Hb variation, and the response of Hb variation to erythropoietin (EPO) were used to analyze the effect of Hb variation on cardiovascular prognosis in PD patients. Results After PD for 3 months, Hb variation
could be analyzed in 333 of the 398 PD patients. In patients with the increase of absolute Hb value of <10g/L and >10g/L, the incidence of new cardiovascular disease (CVD) patients was 27.2% and 12.2% (P<0.05), respectively, and the presence of CVD event was 1/76.2 patients/month and 1/120.1 patients/month, respectively. The percentage of recurrent CVD events in the 3 months of PD was significantly higher in the patients with sustained higher Hb than those in the other 3 Hb variation trend groups (66.7%, P＜0.05). The presence of CVD event was 1/59.2 patients/month in patients with Hb response of <0.01g/L/100IU to EPO treatment, significantly higher than that in the patients with higher Hb response to EPO treatment. Conclusions Hb variation affected the cardiovascular prognosis in PD patients. Our findings suggest that anemia should be treated in PD patients without history of CVD events, and Hb should not be maintained at a higher level in patients with the history CVD events. CVD events occurred more likely in PD patients with lower response to EPO. However, further investigations need to be conducted to confirm our findings.

Key words: Hemoglobin variation, Cardiovascular event, Peritoneal dialysis