中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (08): 547-550.doi: 10.3969/j.issn.1671-4091.2017.08.011

• 临床研究 • 上一篇    下一篇

红细胞分布宽度对维持性血液透析患者贫血及预后的影响

李文1, 付文静1, 邓英辉1, 刘华1, 贾强1   

  1. 首都医科大学宣武医院肾内科
  • 收稿日期:2017-04-10 修回日期:2017-06-26 出版日期:2017-08-12 发布日期:2017-08-12
  • 通讯作者: 贾强 liwenxw@163.com E-mail:lily_8909@163.com
  • 基金资助:

    本课题由国家卫计委卫生公益性行业科研专项资助，项目名称：优化尿毒症患者管理模式的研究，批号：201502010

The effect of red blood cell distribution width on anemia and prognosis in maintenance hemodialysis patients

  • Received:2017-04-10 Revised:2017-06-26 Online:2017-08-12 Published:2017-08-12

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摘要： 目的研究红细胞分布宽度(red blood cell distribution width，RDW)对维持性血液透析(maintained hemodialysis，MHD)患者贫血及预后的影响。方法选择2010 年1 月～2015 年12 月在首都医科大学宣武医院血液净化中心行MHD 治疗≥3 个月、年龄≥18 岁的终末期肾脏病(end stage renal disease，ESRD)的患者252 例，收集以上患者血常规、肾功能、重组人红细胞生成素(recombinant human erythropoietin，rHuEPO)用量等，并对以上患者进行随访，终点事件为全因死亡。根据肾性贫血诊断与治疗中国专家共识建议，血红蛋白(hemoglobin，Hb)≥110g/L 为血红蛋白达标，将血红蛋白达标组的患者根据RDW 正常范围的界值(15.0%)分为RDW 正常组和RDW 升高组，对两组患者一般情况、rHuEPO 用量、重组人红细胞生成素/血红蛋白(rHuEPO/Hb)比值等情况进行分析。对MHD 患者全因死亡的危险因素应用COX回归模型进行分析，分析RDW 对MHD 患者全因死亡的预测价值。结果在血红蛋白达标组的患者中，RDW 升高组的患者rHuEPO 用量及rHuEPO/Hb 比值显著高于RDW 正常组(t=7.279，P＜0.001；t=5.762，P＜0.001)；COX 回归模型分析显示RDW 为MHD 患者全因死亡的危险因素(RR=1.752,95% CI 1.320～2.325，P＜0.001)，血红蛋白浓度(RR=0.951，95% CI 0.934～0.968，P＜0.001)和血浆白蛋白浓度(RR=0.900，95% CI 0.850～0.954，P＜0.001)为保护性因素。结论RDW 升高的患者对红细胞生成素反应性较低，RDW 升高为MHD 患者全因死亡的危险因素，血红蛋白浓度和血浆白蛋白浓度为MHD 患者全因死亡的保
护性因素。

关键词: 红细胞分布宽度, 维持性血液透析, 贫血, 重组人红细胞生成素

Abstract: Objective To study the effect of red blood cell distribution width (RDW) on anemia and prognosis in maintenance hemodialysis (MHD) patients. Methods A total of 252 end stage renal disease (ESRD) cases (18 years of age or older) treated with MHD in the Blood Purification Center of Xuanwu Hospital for more than 3 months were enrolled in this study. Medical history, laboratory parameters including blood routine and renal function tests, and recombinant human erythropoietin (rHuEPO) dosage were recruited. They were followed up, and the end-point of this study was the all-cause death. According to renal anemia diagnosis and treatment of Chinese expert consensus recommendations, the standard of hemoglobin level is greater than or equal to 110g/L. Patients with standard hemoglobin level were divided into RDW normal group and RDW elevated group based on the normal RDW limit of 15.0%. General situation, the amount of rHuEPO used, and the recombinant human erythropoietin/hemoglobin (rHuEPO/Hb) ratio were analyzed between the two groups. COX regression analysis was carried out for the risk factors of all-cause death in MHD patients. Results In patients with standard hemoglobin level, rHuEPO dosage and rHuEPO/Hb ratio were higher in RDW elevated group than in RDW normal group (t=7.279, P＜0.001 for rHuEPO dosage; t=5.762, P＜0.001 for rHuEPO/Hb ratio). Multivariate COX regression demonstrated that RDW was the risk factors while Hb and ALB were the protection factors for all- cause death in MHD patients (RR=1.752, 95% CI 1.320～2.325, P＜0.001 for RDW; RR=0.951, 95% CI 0.934～0.968, P＜0.001 for Hb; RR=0.900, 95% CI 0.850～0.954, P＜0.001 for ALB). Conclusions Patients with elevated RDW were less responsive to rHuEPO than those with normal RDW. Higher RDW was the risk factors while Hb and ALB were the protective factors for all-cause death.

Key words: Red blood cell distribution width, Maintenance hemodialysis, Renal anemia, Recombinant human erythropoietin