中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (08): 407-410.doi: 10.3969/j.issn.1671-4091.2016.08.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血红蛋白变异与预后分析

黄鲁生1,陆玮1,谢芸1,季刚1,黄海东1,蒋更如1   

  1. 1. 上海交通大学医学院附属新华医院
  • 收稿日期:2016-02-26 修回日期:2016-05-30 出版日期:2016-08-12 发布日期:2016-07-12
  • 通讯作者: 陆玮: luweixh@126.com E-mail:luweixh68@yahoo.com.cn

The relationship between hemoglobin variability and prognosis in maintenance hemodialysis patients

  • Received:2016-02-26 Revised:2016-05-30 Online:2016-08-12 Published:2016-07-12

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摘要： 目的  回顾分析维持性血液透析(maintenance hemodialysis MHD)患者血红蛋白变异情况，明确血红蛋白变异与预后之间的关系。方法选取2009 年1 月1 日～2013 年5 月31 日期间新进入血液透析的MHD 患者，收集基线资料，首次透析后12 个月为观察期并记录血红蛋白值，随访至2015.5.31。并根据观察期内血红蛋白变化情况分为上升型(rise type，RT)、波动型(wave type，WT)和持续未达标型(continuous low type，CT)。结果205 例MHD 患者入选，平均年龄60.45±13.26 岁，首次透析时血红蛋白92.60±16.35 g/L，血红蛋白≥110 g/L 占16.10%。随访期间62 例住院，39 例死亡，因心血管疾病(cardiovascular disease CVD)住院41 例(66.13%)，因CVD 死亡27 例(69.23%)。多因素Cox 危险比例模型分析发现不同血红蛋白改变类型(波动型和持续未达标型)是发生全因住院和CVD 住院及全因死亡和CVD 死亡的危险因素，血红蛋白持续未达标型患者的全因死亡风险是上升型的3.502 倍[95% CI(1.293,9.485),P=0.014]，且全因住院风险也更高[RR 3.639,95% CI(1.778,7.451),P＜0.001]。持续未达标型患者发生CVD 死亡[RR 4.759,95% CI(1.357,16.689),P=0.015]和CVD 住院[RR 8.424,95% CI(2.511,28.259),P=0.001]风险高。年龄亦是全因死亡[RR 1.064,95% CI(1.034,1.094),P＜0.001]和CVD 死亡[RR1.065,95% CI(1.030,1.102),P＜0.001]的危险因素。结论纠正贫血且维持血红蛋白达标能显著延长MHD患者的生存时间，减少全因及CVD 住院风险。

关键词: 维持性血液透析, 血红蛋白变异, 心血管疾病, 预后

Abstract: Objective A retrospective study of hemoglobin variability in maintenance hemodialysis (MHD) patients to understand the relationship between hemoglobin variability and prognosis. Methods Patients newly initia between Jan 1, 2009 and May 31, 2013 were enrolled in this study. They were followed up until May 31, 2015. According to their hemoglobin levels throughout the 12 months observation period after they entered hemodialysis, they were classified into three hemoglobin variability groups: the rise type group, the wave type group, and the continuous low type group. Results This retrospective study was conducted in
205 patients newly treated with hemodialysis with the mean age of 60.45±13.26 years old. At the time of dialysis initiation, hemoglobin level was 92.60 ± 16.35 g/L, and hemoglobin level ≥110 g/L was found in 33 (16.10%) patients. Sixty-two patients were hospitalized during the follow-up period, and the cause of hospitalization was cardiovascular disease (CVD) in 41 (66.13%) patients. Thirty-nine died during the follow-up period, and 27 (69.23%) of them died of CVD. Multivariate Cox regression analysis showed that the hemoglobin variability of wave type and continuous low type were the risk factors for all-cause and CVD hospitalization; age and the hemoglobin variability of wave type and continuous low type were the risk factors for all-cause and CVD mortality. The risk of all-cause mortality in the continuous low type patients was 3.502 times higher that in the rise type patients (95%CI 1.293~9.485, P=0.014), while the risk of all-cause hospitalization was also higher in the continuous low type patients than in the rise type patients (RR=3.639, 95% CI 1.778~7.451, P＜0.001). The continuous low type patients had a higher risk of CVD mortality (RR=4.759, 95% CI 1.357~ 16.689, P=0.015) and CVD hospitalization (RR=8.424, 95% CI 2.511~28.259, P=0.001). Conclusions Correction of anemia and maintenance of a stable hemoglobin level can prolong survival time and reduce the
risks of all-cause and CVD hospitalization in MHD patients.

Key words: Maintenance hemodialysis, Hemoglobin variability, Cardiovascular disease, Prognosis