腹膜透析患者血红蛋白变异性与全因死亡及心血管疾病死亡风险的相关性  

Association between hemoglobin variability and risk of all-cause death and cardiovascular death in peritoneal dialysis patients

作　　者：黄淑婷 艾军[1] 霍志濠 朱露 龚妮容[1] 钟晓红[1] 孔耀中[4] 刘德慧[5] 窦献蕊 张广清 Huang Shuting;Ai Jun;Huo Zhihao;Zhu Lu;Gong Nirong;Zhong Xiaohong;Kong Yaozhong;Liu Dehui;Dou Xianrui;Zhang Guangqing(Department of Nephrology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;School of Nursing,Southern Medical University,Guangzhou 510515,China;Department of Nephrology,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Nephrology,Foshan First People's Hospital,Foshan 528000,China;Department of Nephrology,Ganzhou People's Hospital,Ganzhou 341000,China;Department of Nephrology,Shunde Hospital,Southern Medical University,Foshan 528308,China;Office of Hospital,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院肾内科,广州510515 [2]南方医科大学护理学院,广州510515 [3]广州中医药大学第一附属医院肾病科,广州510405 [4]佛山市第一人民医院肾内科,佛山528000 [5]赣州市人民医院肾内科,赣州341000 [6]南方医科大学顺德医院肾内科,佛山528308 [7]南方医科大学南方医院医院办公室,广州510515

出　　处：《中华肾脏病杂志》2024年第8期611-618,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(82370744);广东省慢性肾病临床医学研究中心(2020B1111170013)。

摘　　要：目的探讨腹膜透析(peritoneal dialysis,PD)患者血红蛋白变异性(hemoglobin variability,Hbvar)与全因死亡及心血管疾病死亡风险的关系,以期为降低PD人群死亡风险提供依据。方法该研究为多中心、回顾性队列研究,收集2008年7月1日至2019年12月31日在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院及赣州市人民医院规律PD患者的临床资料。以PD前基线及PD后第1年内血红蛋白计算Hbvar,根据第1年Hbvar三分位数将患者分为低变异性组、中变异性组和高变异性组,比较3组基线临床资料的差异。随访终点为患者死亡、转血液透析、转肾移植、转其他中心、失访或截至2021年12月31日。采用Cox回归分析模型分析第1年Hbvar与全因死亡及心血管疾病死亡的相关性,并使用FineGray竞争风险回归模型评估竞争事件对死亡风险的影响。结果该研究纳入1562例PD患者,年龄(47.6±13.8)岁,男性821例(52.6%),基线血红蛋白为81(69,94)g/L,PD第1年Hbvar为26.6(16.7,40.3)g/L。低变异性组(<20.0 g/L)、中变异性组(20.0~35.5 g/L)、高变异性组(≥35.5 g/L)患者年龄、体重指数、血清白蛋白、血红蛋白、血清肌酐、血清钙、血清磷、全段甲状旁腺素及肾素血管紧张素系统抑制剂使用比例的差异均有统计学意义(均P<0.05)。随访时间为33(19,51)个月,患者死亡208例(13.3%),其中心血管疾病死亡111例(53.4%)。多因素Cox回归分析结果显示,第1年高Hbvar是PD患者全因死亡(HR=0.98,95%CI 0.97~0.99,P=0.018)和心血管疾病死亡(HR=0.98,95%CI 0.97~0.99,P=0.041)风险低的独立影响因素。以低变异性组为参照,高变异性组全因死亡(HR=0.56,95%CI 0.37~0.82,P=0.003)及心血管疾病死亡(HR=0.54,95%CI 0.31~0.95,P=0.032)风险最低。竞争风险回归模型分析结果显示,第1年Hbvar与全因死亡(HR=0.98,95%CI 0.97~0.99,P=0.041)和心血管疾病死亡(HR=0.98,95%CI 0.97~0.99,P=0.039)风险仍呈负相关。Objective To explore the relationship between hemoglobin variability(Hb-var)and risk of all-cause death and cardiovascular death in patients with peritoneal dialysis(PD),and to provide basis for reducing the risk of death in PD patients.Methods It was a multicenter retrospective cohort study.The clinical data of regular PD patients from Nanfang Hospital of Southern Medical University,Shunde Hospital of Southern Medical University,Foshan First People's Hospital and Ganzhou People's Hospital from July 1,2008 to December 31,2019 were collected.Hbvar was calculated based on hemoglobin at baseline before PD and in the first year after PD.The patients were divided into low Hb-var group,moderate Hb-var group and high Hb-var group according to the tertiles of first year Hb-var,and the differences of baseline clinical data among three groups were compared.Follow-up endpoints included death,transfer to hemodialysis,transfer to kidney transplantation,transfer to other centers,loss of follow-up,or on December 31,2021.Cox regression analysis model was used to analyze the association of the first-year Hb-var with all-cause death and cardiovascular death.Fine-Gray competitive risk regression model was used to evaluate the impact of competitive events on mortality risk.Results A total of 1562 patients with PD were included in the study,aged(47.6±13.8)years old,with 821 males(52.6%)and baseline hemoglobin of 81(69,94)g/L.Hb-var in the first year of PD was 26.6(16.7,40.3)g/L.There were statistically significant differences in age,body mass index,serum albumin,hemoglobin,serum creatinine,serum calcium,serum phosphorus,intact parathyroid hormone and the proportion of renin-angiotensin system inhibitors among low Hb-var group(<20.0 g/L),moderate Hb-var group(20.0-35.5 g/L)and high Hb-var group(≥35.5 g/L,all P<0.05).The follow-up time was 33(19,51)months,and 208 patients(13.3%)died,among which 111 patients(53.4%)died of cardiovascular death.Multivariate Cox regression analysis showed that the higher Hb-var in the first year,the low

关 键 词：腹膜透析 血红蛋白类 死亡率 血红蛋白变异性 

分 类 号：R692.5[医药卫生—泌尿科学]