血红蛋白波动对腹膜透析患者心血管预后的影响  

Effect of hemoglobin volatility on cardiovascular prognosis in peritoneal dialysis patients

作　　者：杨文娟 田娜[2,3] 张倩[4] 王艳 王丽 宋淑华[2,3] 马小琴 赵彩萍[2,3] 陈孟华 Yang Wenjuan;Tian Na;Zhang Qian;Wang Yan;Wang Li;Song Shuhua;Ma Xiaoqin;Zhao Caiping;Chen Menghua(School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Department of Nephrology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Ningxia Clinical Research Center for Kidney Disease,Yinchuan 750004,China;Department of Nephrology,Yuncheng Central Hospital,Yuncheng City of Shanxi Province 044000,China)

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]宁夏医科大学总医院肾内科,银川750004 [3]宁夏肾脏病临床研究中心,银川750004 [4]山西运城市中心医院肾内科,运城044000

出　　处：《中华肾脏病杂志》2021年第4期313-320,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81960144)。

摘　　要：目的探讨腹膜透析(peritoneal dialysis,PD)患者血红蛋白(hemoglobin,Hb)波动与心血管预后的关系。方法回顾性分析2003年5月1日至2014年10月31日宁夏医科大学总医院PD中心稳定透析>3个月并规律随访至少1年的PD患者资料,使用Hb周期性法根据透析后1个月、3个月、6个月、12个月Hb较基线变化绝对值的平均值分为低波动组(≤10 g/L)、中波动组(>10~20 g/L)及高波动组(>20 g/L),比较各组之间的基线资料。采用Kaplan-Meier生存分析和Cox回归方程分析3组患者Hb波动与心血管相关死亡、全因死亡之间的关系。根据改善全球肾脏病预后组织(KDIGO)指南及相关文献,将患者按研究终点(心血管死亡和全因死亡)时的Hb水平分为达标组(Hb≥110 g/L)和未达标组(Hb<110 g/L),采用Cox回归分析法比较两组Hb平均波动水平与心血管相关死亡的关系。采用多因素线性回归法分析PD患者Hb波动的相关因素。结果共纳入267例PD患者,男性160例(59.93%),年龄(52.66±13.72)岁,中位透析龄37(21,61)个月。患者基线Hb(透析前)为(80.16±14.89)g/L,研究结束时Hb为(105.34±22.08)g/L。与低、中波动组比较,高波动组体重指数、基线Hb水平均较低(均P<0.05)。与低波动组相比,中、高波动组估计肾小球滤过率水平均较低,高波动组尿素氮水平较高(均P<0.05)。与中波动组相比较,高波动组促红细胞生成素用量较多(P<0.05)。Kaplan-Meier生存分析结果显示,三组患者以心血管相关死亡为研究终点事件的生存率(Log-rankχ^(2)=2.961,P=0.228)及整体生存率(Log-rankχ^(2)=0.735,P=0.693)差异均无统计学意义。Cox回归分析结果显示,在校正了年龄、性别、血肌酐、血白蛋白后,Hb平均波动越大,心血管相关死亡风险越低(HR=0.972,95%CI 0.947~0.999,P=0.040);在未达标组人群中,校正相关混杂因素后,Hb波动大仍是心血管相关死亡风险低的保护因素(HR=0.946,95%CI 0.903~0.992,P=0.022),但与全因死亡均无�Objective To investigate the effect of hemoglobin(Hb)volatility on cardiovascular prognosis in peritoneal dialysis(PD)patients.Methods Retrospective cohort study was designed.Patients undergoing stable PD for more than 3 months and followed up regularly for at least 1 year were enrolled from May 1,2013 to October 31,2014 in the General Hospital of Ningxia Medical University.According to the Hb variation based on the mean changes in Hb standard deviation at 1 month,3 months,6 months,12 months over baseline Hb,all patients were divided into low volatility group(≤10 g/L),moderate volatility group(>10-20 g/L)and high volatility group(>20 g/L),and baseline information were compared among these groups.Kaplan-Meier survival analysis and Cox regression equation were used to analyze the relationship between Hb variation and cardiovascular mortality and all-cause mortality.Besides,the patients were divided into qualified group(Hb≥110 g/L)and substandard group(Hb<110 g/L)by the Hb level at the study endpoint(cardiovascular death and all-cause death)according to KDIGO guidelines and relevant literature.Cox regression analysis was used to analyze the relationship between Hb variation and cardiovascular death in qualified group or substandard group.Multivariate linear regression analysis was used to analyze the related factors of Hb fluctuation in PD patients.Results A total of 267 patients were enrolled.There were 160 males(59.93%)in this study.The age was(52.66±13.72)years old,and the median dialysis age was 37(21,61)months.The patients'baseline Hb(before dialysis)was(80.16±14.89)g/L and at the end of the study Hb was(105.34±22.08)g/L.Body mass index and baseline Hb levels in the high volatility group were lower than those in low volatility group and moderate volatility group(all P<0.05).Both moderate and high volatility groups had lower estimated glomerular filtration rate than that in low volatility group,and high volatility group had higher urea nitrogen level than that in low volatility group(all P<0.05).The amoun

关 键 词：腹膜透析 心血管疾病 预后 血红蛋白波动 

分 类 号：R692.5[医药卫生—泌尿科学]