中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (08): 537-542.doi: 10.3969/j.issn.1671-4091.2020.08.009

• 临床研究 • 上一篇    下一篇

红细胞分布宽度动态变化可预测腹膜透析患者死亡

李天慧1,赵班1,陈爱群1,王海涛1,贾莺梅1,毛永辉1   

  1. 1北京医院肾内科，国家老年医学中心中国医学科学院老年医学研究所
    (李天慧、赵班为本文共同第一作者)

  • 收稿日期:2020-02-05 修回日期:2020-06-19 出版日期:2020-08-12 发布日期:2020-08-12
  • 通讯作者: 毛永辉 maoyonghui0214@bjhmoh.cn E-mail:maoyonghui0214@bjhmoh.cn
  • 基金资助:
    重大疾病新药临床评价技术平台建设(2017ZX09304026)

Dynamic change of red blood cell distribution width predicts mortality in peritoneal dialysis patients

  1. 1Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric medicine, Chinese Academy
    of Medical Sciences, Beijing 100730, China
    LI Tian-hui and ZHAO Ban contributed equally to this article
  • Received:2020-02-05 Revised:2020-06-19 Online:2020-08-12 Published:2020-08-12

PDF

811

摘要： 【摘要】目的探讨腹膜透析患者基线红细胞分布宽度(red blood cell distribution width，RDW)、时间平均RDW 及RDW 动态变化趋势与全因死亡的关系。方法回顾性分析2005 年7 月1 日～2017年6 月30 日北京医院腹膜透析中心规律透析3 个月以上共89 例患者的临床资料，随访至2018年12月31日。分析基线RDW、时间平均RDW 与腹膜透析患者死亡的相关性；根据受试者工作特征曲线(receiver operating characteristic curve，ROC)确定时间平均RDW 最佳截断值，以基线RDW 是否大于正常值和时间平均RDW 是否大于最佳预测截断值分为低基线RDW 并低时间平均RDW 组、低基线RDW 并高时间平均RDW 组、高基线RDW 并低时间平均RDW 组、高基线RDW 并高时间平均RDW 组，观察4 组患者的预后差异。结果患者平均年龄(62.6±13.1)岁，中位透析龄48.0(32.0,66.0)个月。随访期内死亡33 例(37.1% )。相关性分析显示基线RDW、时间平均RDW 均和死亡相关(r=0.365, P＜0.001；r=0.520, P＜0.001)；COX 多因素回归分析提示时间平均RDW 和腹膜透析患者的全因死亡独立相关(HR=1.833, 95%CI：1.158～2.899，P=0.010)；时间平均RDW 的ROC 面积为0.881(95%CI:0.686～0.808，P＜0.001)，最佳预测截断值为14.1%；较基线及随访期RDW 均较低的“双低”组，基线及随访期RDW 均较高的“双高”组或“基线低随访期高”组患者的累积生存率更低(c2=17.172, P＜0.001；c2=11.232, P=0.001)。结论时间平均RDW 水平可独立预测腹膜透析患者的全因死亡；RDW 处于持续高水平或基线正常而随访期升高患者的生存预后较差。

关键词: 腹膜透析, 死亡率, 红细胞分布宽度

Abstract: 【Abstract】Objective To explore the relationship between the values of baseline red blood cell distribution width (RDW), time-averaged RDW and RDW dynamic trends and the all-cause mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods We reviewed 89 incident patients undergoing (CAPD) between July 1, 2005 and June 30, 2017 treated at the Peritoneal Dialysis Center of Beijing Hospital and examined the changes of RDW from baseline to December 31, 2018. We then assessed the relationship between the values of baseline RDW and time-averaged RDW and the risk of mortality. The optimal cut-off value of time- averaged RDW was determined based on receiver operating characteristic (ROC) curve. We assigned the patients into four groups according to baseline RDW and time-averaged RDW: "double-low" RDW group at baseline and follow-up; low baseline and high follow-up RDW group; high baseline and low followup RDW group; and "double-high" RDW group at baseline and follow-up. The difference of prognosis was observed among the four groups. Results This study included 89 patients, with an average age of 62.6 years and a mean follow-up duration of 48.0 (32.0～66.0) months. Thirty-three patients (37.1%) died in the followup period. Baseline RDW and time-averaged RDW correlated positively with mortality (r=0.365, P＜0.001;r=0.520, P＜0.001). Multivariate COX regression analysis showed that time-averaged RDW was a significant predictor of all-cause mortality in the CAPD patients (HR=1.833, 95% CI: 1.158～2.899, P=0.010). The area under the curve (AUC) in ROC for time-averaged RDW was 0.881 (95％ CI: 0.686～0.808, P＜0.001), and the optimal prediction cut-off value was 14.1%. Compared with the "double-low" RDW group at baseline and follow-up, the cumulative survival rate was lower in the "double-high" RDW group and low baseline and high follow-up RDW group (c2=17.172, P＜0.001; c2=11.232,P=0.001). Conclusions Higher time-averaged RDW was associated with a higher risk of mortality among CAPD patients. Compared with the patients with persistently low RDW, those with persistently high RDW or low baseline and high follow-up RDW had poorer survival outcomes.

Key words: Peritoneal dialysis, Mortality, Red cell distribution width

中图分类号: