中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (08): 617-622.doi: 10.3969/j.issn.1671-4091.2025.08.001

• 临床研究 •    下一篇

红细胞分布宽度与高敏C反应蛋白的交互作用对维持性血液透析患者心血管事件的影响

郎国志   代玲贤    杨金航   蒋红樱   

  1. 650000 昆明，1昆明医科大学第二附属医院肾脏内科
  • 收稿日期:2025-01-03 修回日期:2025-03-17 出版日期:2025-08-12 发布日期:2025-08-12
  • 通讯作者: 蒋红樱 E-mail:1627248965@qq.com
  • 基金资助:
    云南省万人计划“名医”人才专项资金(YNWR-MY-2019-075)

Effect of the interaction between red blood cell distribution width and high-sensitivity C-reactive protein on cardiovascular events in maintenance hemodialysis patients

LANG Guo-zhi， DAI Ling-xian，YANG Jin-hang，JIANG Hong-ying   

  1. Department of Nephrology，Second Affiliated Hospital of Kunming Medical University，Kunming 650000，China
  • Received:2025-01-03 Revised:2025-03-17 Online:2025-08-12 Published:2025-08-12
  • Contact: 650000 昆明，1昆明医科大学第二附属医院肾脏内科 E-mail:1627248965@qq.com

摘要： 目的  探讨红细胞分布宽度(red blood cell distribution width，RDW)与高敏C反应蛋白(hsCRP)的交互作用对维持性血液透析(maintenance hemodialysis，MHD)患者心血管事件的影响。 方法 纳入2020年1月─2022年6月在昆明医科大学第二附属医院接受MHD的患者。根据患者的RDW水平中位数，分为高RDW组(RDW≥14.75%，n=102)和低RDW组(RDW＜14.75%，n=102)；根据hsCRP水平分为高hsCRP组(hsCRP＞3 mg/L，n=127)和低hsCRP组(hsCRP≤3 mg/L，n=77)。采用Kaplan-Meier生存曲线及COX回归模型分析不同hsCRP组别间RDW与患者心血管事件的相关性及RDW与hsCRP的交互作用对心血管事件的影响。采用限制性立方样条回归模型分析RDW水平与MHD患者心血管事件之间的剂量-反应关系。 结果  共纳入204例MHD患者，随访期间共发生心血管事件76例(37.3%)。Kaplan-Meier生存分析发现，与低RDW组相比，高hsCRP组中的高RDW组患者的心血管事件发生率显著增加(c2=12.831，P＜0.001)，而在低hsCRP组中则差异无统计学意义(c2=0.072，P=0.788)。多因素COX回归分析发现， RDW和hsCRP与患者心血管事件之间存在交互作用(HR=1.001，95% CI：1.000～1.001，P=0.014)，与低hsCRP-低RDW组相比，高hsCRP-高RDW组的心血管事件发生风险显著增加(HR=2.215，95% CI：1.108～4.427，P=0.024)。限制性立方样条图显示，RDW水平与心血管事件发生风险之间呈线性剂量-反应关系(P整体＜0.001，P非线性=0.853)。结论  RDW和hsCRP与MHD患者心血管事件间存在交互作用，高RDW和高hsCRP二者同时存在时患者心血管事件发生风险显著增加。

关键词: 血液透析, 红细胞分布宽度, 高敏C反应蛋白, 心血管事件

Abstract: Objective   To explore the effect of the interaction between red blood cell distribution width (RDW) and high-sensitivity C-reactive protein (hsCRP) on cardiovascular events in  maintenance hemodialysis (MHD) patients.  Methods   Patients who received MHD at the Second Affiliated Hospital of Kunming Medical University from January 2020 to June 2022 were enrolled. Based on median RDW levels, patients were divided into a high-RDW (RDW≥4.75%, n=102) and a low-RDW group (RDW＜14.75%, n=102). According to hsCRP level, patients were divided into a high-hsCRP (hsCRP＞3 mg/L, n=127) and a low-hsCRP group (hsCRP≤3 mg/L, n=77). Kaplan-Meier survival curves and COX regression models were used to explore correlations between RDW and cardiovascular events across hsCRP strata and their interaction effect. A restricted cubic spline regression model was used to analyze the dose-response relationship between RDW levels and cardiovascular events.  Results   A total of 204 MHD patients were included in this study, and there were 76 cases (37.3%) of cardiovascular events during the follow-up period. Kaplan-Meier analysis revealed a significantly higher cardiovascular event incidence in the high-RDW versus low-RDW group within the high-hsCRP stratum (χ²=12.831, P＜0.001), but not in the low-hsCRP group (χ²=0.072, P=0.788).  Multivariate Cox regression analysis revealed a significant interaction between RDW and hsCRP on cardiovascular events (HR=1.001, 95% CI:1.000～1.001, P=0.014). Compared with the low-hsCRP-low RDW group，the high-hsCRP-high RDW group had a significantly higher risk of cardiovascular events (HR=2.215, 95% CI: 1.108～4.427, P=0.024). The restricted cubic spline plot showed a linear dose-response relationship between RDW levels and the risk of cardiovascular events (P＜0.001, Pnonlinea r=0.853).  Conclusion   RDW and hsCRP levels have a significant interaction on cardiovascular events, and the coexistence of high RDW and high hsCRP significantly increases the risk of cardiovascular events in MHD patients. 

Key words: Hemodialysis, Red blood cell distribution width, High-sensitivity C-reactive protein, Cardiovascular events

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