外周血白细胞计数及其分类与血液透析患者心血管事件发生及一年病死率相关  

Decreased lymphocyte and increased monocyte count in peripheral blood is associated with cardiovascular disease and one- year mortality in maintenance hemodialysis patients

作　　者：项方方[1] 曹学森[1] 徐少伟[1] 沈波[1] 邹建洲[1] 滕杰[1] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾内科,上海200032

出　　处：《中华肾脏病杂志》2013年第8期589-594,共6页Chinese Journal of Nephrology

基　　金：上海市科委基金资助（11XD1401400）

摘　　要：目的探讨血液透析（血透）患者外周血白细胞计数及其分类与心血管事件（CVD）发生及一年预后的关系。方法收集2009年3月至2011年3月期间在复旦大学上海医学院附属中山医院接受血液透析治疗的终末期肾病患者临床及血清学资料，并进行12个月的随访。采用Spearman相关和线性回归方法分析外周血白细胞及其分类与其他临床及实验室指标的相关关系。用t检验比较连续变量在CVD事件发生组和无CVD事件发生组的差异，用卡方检验比较分类变量差异。Kaplan—Meier生存分析和Cox风险比例模型分析白细胞及其分类对一年病死率的预测作用。结果共371例血液透析患者入组。与无CVD事件发生组相比，CVD组患者淋巴细胞数显著降低[（1．17±0．38）比（1．34±0．51），P〈0．05]，单核细胞数显著升高[（0．44±0．15）比（0．37±0．15），P〈0．01]。淋巴细胞数升高者病死率较低（P〈0．01），单核细胞数升高者病死率较高（P〈0．01），其预测价值高于高敏C反应蛋白。结论外周血白细胞计数与血液透析患者CVD的发生相关，淋巴细胞数降低和单核细胞数升高是血透患者1年病死率的独立危险因素。Objective To investigate the association between peripheral white blood cell count including its subtypes and cardiovascular disease （CVD） incidence and one-year all-cause mortality in maintenance hemodialysis （MHD） patients. Methods A total of 371 MHD patients at Zhongshan Hospital, Fudan University between March 2009 and February, 2011 were enrolled. Demographic, hematological, nutritional and inflammatory markers were obtained. All patients were followed for one year to investigate the risks for CVD event and mortality. Spearman correlation and linear regression were used to assess the relationship between white blood cell count and other laboratory parameters. Difference in categorical factors between two groups were determined with Chi-square test, Difference in continuous values between two groups were assessed with t test. Kaplan- Meier analysis and Cox proportional hazards model were applied to assess one- year mortality predictors. Results Patients with CVD event had lower lymphocyte count level （1.17±0.38 vs 1.34±0.51, P〈0.05） and higher monocyte count level （0.44 ± 0.15 vs 0.37 ± 0.15, P〈0.01） than those without CVD event. Cox proportional hazard regression showed that an increased lymphocyte count was associated with reduced mortality risk, 95% CI： 0.136-0.719, P 〈 0.01） and that an increased monocyte count was associated with increased mortality risk, 95% CI： 2.657- 74.396, P〈0.01） after adjustment for hsCRP. Conclusion Decreased lymphocyte level and increased monocyte level are significantly related to CVD event and are independent predictors of increased one- year all- cause mortality risk in MHD patients.

关 键 词：血液透析 心血管疾病 淋巴细胞 单核细胞 病死率 

分 类 号：R459.5[医药卫生—治疗学]