维持性血液透析患者血红蛋白变异与预后分析  

The relationship between hemoglobin variability and prognosis in maintenance hemodialysis patients

作　　者：黄鲁生 陆玮[1] 谢芸[1] 季刚[1] 黄海东[1] 蒋更如[1] 

机构地区：[1]上海交通大学医学院附属新华医院,上海200092

出　　处：《中国血液净化》2016年第8期407-410,共4页Chinese Journal of Blood Purification

摘　　要：目的回顾分析维持性血液透析（maintenance hemodialysis MHD）患者血红蛋白变异情况,明确血红蛋白变异与预后之间的关系。方法选取2009年1月1日~2013年5月31日期间新进入血液透析的MHD患者,收集基线资料,首次透析后12个月为观察期并记录血红蛋白值,随访至2015.5.31。并根据观察期内血红蛋白变化情况分为上升型（rise type,RT）、波动型（wave type,WT）和持续未达标型（continuous low type,CT）。结果 205例MHD患者入选,平均年龄60.45±13.26岁,首次透析时血红蛋白92.60±16.35 g/L,血红蛋白≥110 g/L占16.10%。随访期间62例住院,39例死亡,因心血管疾病（cardiovascular disease CVD）住院41例（66.13%）,因CVD死亡27例（69.23%）。多因素Cox危险比例模型分析发现不同血红蛋白改变类型（波动型和持续未达标型）是发生全因住院和CVD住院及全因死亡和CVD死亡的危险因素,血红蛋白持续未达标型患者的全因死亡风险是上升型的3.502倍[95%CI（1.293,9.485）,P=0.014],且全因住院风险也更高[RR 3.639,95%CI（1.778,7.451）,P〈0.001]。持续未达标型患者发生CVD死亡[RR 4.759,95%CI（1.357,16.689）,P=0.015]和CVD住院[RR 8.424,95%CI（2.511,28.259）,P=0.001]风险高。年龄亦是全因死亡[RR 1.064,95%CI（1.034,1.094）,P〈0.001]和CVD死亡[RR1.065,95%CI（1.030,1.102）,P〈0.001]的危险因素。结论纠正贫血且维持血红蛋白达标能显著延长MHD患者的生存时间,减少全因及CVD住院风险。Objective A retrospective study of hemoglobin variability in maintenance hemodialysis （MHD） patients to understand the relationship between hemoglobin variability and prognosis. Methods Patients newly initia between Jan 1, 2009 and May 31, 2013 were enrolled in this study. They were followed up until May 31, 2015. According to their hemoglobin levels throughout the 12 months observation period after they entered hemodialysis, they were classified into three hemoglobin variability groups： the rise type group, the wave type group, and the continuous low type group. Results This retrospective study was conducted in 205 patients newly treated with hemodialysis with the mean age of 60.45±13.26 years old. At the time of dialysis initiation, hemoglobin level was 92.60±16.35 g/L, and hemoglobin level ≥110 g/L was found in 33 （16.10%） patients. Sixty-two patients were hospitalized during the follow-up period, and the cause of hospitalization was cardiovascular disease （CVD） in 41 （66.13%） patients. Thirty-nine died during the follow-up period, and 27 （69.23%） of them died of CVD. Multivariate Cox regression analysis showed that the hemoglobin variability of wave type and continuous low type were the risk factors for all-cause and CVD hospitalization; age and the hemoglobin variability of wave type and continuous low type were the risk factors for all-cause and CVD mortality. The risk of all-cause mortality in the continuous low type patients was 3.502 times higher that in the rise type patients （95% CI 1.293-9.485, P=-0.014）, while the risk of all-cause hospitalization was also higher in the continuous low type patients than in the rise type patients （RR=3.639, 95% CI 1.778-7.451, P〈0.001）. The continuous low type patients had a higher risk of CVD mortality （RR=4.759, 95% CI 1.357- 16.689, P=-0.015） and CVD hospitalization （RR=8.424, 95% CI2.511-28.259, P=0.001）. Conclusions Correction of anemia and maintenance of a stable hemoglobin level can prolong survival time and reduce th

关 键 词：维持性血液透析 血红蛋白变异 心血管疾病 预后 

分 类 号：R318.16[医药卫生—生物医学工程]