维持性血液透析患者血红蛋白变异与心脑血管事件的关联  

Association between hemoglobin variability and cardio-cerebrovascular events in maintenance hemodialysis patients

作　　者：钟晓菁[1] 吴青[1] 张丽红[1] 范伟峰[1] 罗丽红[1] 顾勇[2] 牛建英[1] ZHONG Xiaojing WU Qing ZHANG Lihong FAN Weifeng LUO Lihong GU Yong NIU Jianying(The Fifth People＇s Hospital of Shanghai, Fudan University, Shanghai 200240, China Hua Shan Hospital, Fudan University, Shanghai 200040, China)

机构地区：[1]复旦大学附属上海市第五人民医院肾内科,上海200240 [2]复旦大学附属华山医院肾内科

出　　处：《肾脏病与透析肾移植杂志》2017年第3期212-216,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：上海市科委课题(16ZR1426900);上海市卫计委课题(20134058);闵行区科委课题(2013MHZ015)

摘　　要：目的:贫血是维持性血液透析患者常见并发症之一,且血红蛋白难以维持稳定。本研究旨在探讨血红蛋白变异性与心脑血管事件及死亡的关联,为探索并制定更优化诊疗方案提供临床依据。方法:本研究对80例维持性血液透析患者随访9个月,每月检测血红蛋白水平,对血红蛋白及各变异性指标组间临床不良事件的发生情况进行比较分析。结果:临床心脑血管不良事件的独立危险因素为血红蛋白标准差、变异系数(%)、差值平均值;而血红蛋白平均值为其保护性因素。影响脑血管事件的独立危险因素为血红蛋白标准差和变异系数。影响心血管事件的独立危险因素为血红蛋白差值平均值。生存回归显示血红蛋白差值平均值为死亡的独立危险因素,血红蛋白平均值为保护性因素。结论:维持性血液透析患者普遍存在血红蛋白波动,其与心血管事件和死亡的相关性可能因判断血红蛋白变异性的标准不同而有差异。Objective：Anemia is a common complication in the maintenance hemodialysis（MHD） patients,and it is difficult to keep the real-time hemoglobin level stable. This study aimed to analyze the risk of cardio-cerebrovascular events and death in terms of hemoglobin variability. Methodology：The hemoglobin concentration of eighty MHD patients were tested monthly,at the end of 9-months observation,patients were grouped according to the indicators of hemoglobin variability. The observational end point were death,cardiovascular or cerebrovascular events. Results：The independent risk factors of the clinical adverse events were the hemoglobin standard deviation,coefficient variation,mean differences between9 times results,while the hemoglobin concentration was protective factor; the independent risk factors of the cerebrovascular events were the hemoglobin standard deviation and coefficient variation; the independent risk factors of the cardiovascular events was mean differences between 9 times results. Multiple stepwise regression analysis showed that mean differences between 9 times results were an independent risk factor of death,while the hemoglobin concentration was protective factor.Conclusion：Hemoglobin variability is common in the anemic patients undergoing MHD. Lower hemoglobin level and higher residual standard deviation（SD） of hemoglobin level are associated with higher risk of clinical adverse events.

关 键 词：血液透析 心血管事件 脑血管事件 死亡 血红蛋白变异性 

分 类 号：R459.5[医药卫生—治疗学]