中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (03): 148-151.doi: 10.3969/j.issn.1671-4091.2015.03.00

• 临床研究 • 上一篇    下一篇

血红蛋白检测频率对血红蛋白变异的影响及与血透患者预后的关系研究

李萍,陈孜瑾,蒋钻红,马晓波,俞海瑾,陈晓农   

  1. 上海交通大学医学院附属瑞金医院肾脏科
  • 收稿日期:2015-01-19 修回日期:2015-01-22 出版日期:2015-03-12 发布日期:2015-04-20
  • 通讯作者: 陈晓农 xiaonong@medmail.com.cn E-mail:xiaonong@medmail.com.cn
  • 基金资助:
    上海市自然科学基金(14ZR1425400)；上海市科委医学引领项目(114119b2700)

Hemoglobin measurement frequency on the detection of hemoglobin variation and the correlation between hemoglobin variation and mortality in maintenance hemodialysis patients

  • Received:2015-01-19 Revised:2015-01-22 Online:2015-03-12 Published:2015-04-20

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摘要： 【摘要】目的 探讨血红蛋白(Hb)检测频率对维持性血液透析(MHD)患者血红蛋白变异的影响，以及血红蛋白变异与血液透析患者临床预后的相关性。 方法 随访2011年1月在上海交通大学医学院附属瑞金医院肾脏内科血液透析中心进行维持性透析的患者，比较不同血红蛋白检测频率：每2月检测1次Hb(2011年1月～2012年12月)与每月检测1次Hb(2013年1月～2014年7月)对血红蛋白变异的影响。观察2013年1月～2013年6月在透析患者的血红蛋白变异情况，研究终点是心血管事件和全因死亡。分析血红蛋白变异与死亡率的相关性。 结果 每2月检测1次，其血红蛋白变异均较每月检测1次明显升高，差异有统计学意义(P＜0.05)。2组血红蛋白变异度分组类型均主要是围绕目标范围下限波动(LAL)，每2月检测1次占56.7%，每月检测1次占68.7%；血红蛋白变异与死亡率的相关性分析显示：年龄是主要影响因素，统计学效应较大，剔除年龄影响后，与高波动(HA)比较，LAL患者死亡率显著增高[OR值6.186, 95% CI(1.277～29.956), P=0.024]。 结论 增加血红蛋白检测频率可以减少血红蛋白变异。高血红蛋白变异与死亡率并无显著相关性。但血红蛋白在目标值以下小波动与血液透析患者死亡率增高相关。

关键词: 维持性血液透析, 血红蛋白检测频率, 血红蛋白变异度, 死亡率

Abstract: 【Abstract】 Objective To investigate the hemoglobin (Hb) measurement frequency on the detection of Hb variation, and the correlation between Hb variation and mortality in maintenance hemodialysis (MHD) patients. Methods Maintenance hemodialysis patients treated in the Department of Nephrology, Shanghai Ruijin Hospital from Jan. 1st, 2011 were followed up. Hb measurement was performed once every 2 months from Jan. 2011 to Dec. 2012, and once every month from Jan. 2013 to July. 2014. Hb measurement frequency on the detection of Hb variation in these patients was then evaluated. Hb variation was described by residual standard deviation (Res-SD), fluctuation across threshold of the Hb level, and Hb variation amplitude. In the retrospective study, we analyzed Hb variation in MHD patients treated in the period from Jan. 2013 to June 2013, as well as the correlation between Hb variation and mortality using cardiovascular events and all-cause death as the study endpoints. Results Hb variation was higher in the patients with Hb measurement once every 2 months than in those with Hb measurement once every month (P＜0.05). Hb fluctuated in low amplitude around the lower limit of the targeted Hb level in 56.7% patients with Hb measurement once every 2 months and in 68.7% patients with Hb measurement once every month. Correlation analysis showed that age was the major and statistically significant influencing factor for Hb variation. After exclusion of age factor, the patients with low Hb level had higher mortality rate as compared to those with high amplitude Hb fluctuation (OR=6.186, 95% CI 1.277～29.956, P=0.024). Conclusion The increase of Hb measurement frequency can obviously reduce the possibility of Hb variation. Higher Hb variation was unrelated to mortality. However, mortality increased in MHD patients with low amplitude fluctuation around the lower limit of the targeted Hb level

Key words: maintenance hemodialysis, Hemoglobin detection frequency, hemoglobin variability, mortality