MHD患者预后的影响因素及外周血相关指标的预测价值  

Prognostic Factors of MHD Patients and Predictive Value of Peripheral Blood Related Indicators

作　　者：王艳 陈亦男 徐淑琴 WANG Yan;CHEN Yinan;XU Shuqin(Department of Laboratory Medicine,Yingtan People's Hospital,Yingtan 335000,China;不详)

机构地区：[1]鹰潭市人民医院检验科,江西鹰潭335000 [2]鹰潭市中医院病理科,江西鹰潭335000

出　　处：《中国医学创新》2024年第31期179-183,共5页Medical Innovation of China

摘　　要：目的:探讨维持性血液透析(MHD)患者预后的影响因素及外周血相关指标的预测价值。方法:选取2022年1月—2023年1月鹰潭市人民医院收治的行MHD的157例终末期肾病患者为研究对象。截至2023年12月,根据患者存活情况分为存活组和死亡组。比较存活组和死亡组临床资料,logistic回归分析影响MHD患者预后的危险因素,绘制受试者操作特征(ROC)曲线分析外周血铁蛋白、血红蛋白、白蛋白、钙、磷对不良预后的评估价值。结果:存活组与死亡组分别120、37例。死亡组透析时间长于存活组,铁蛋白、磷均高于存活组,血红蛋白、白蛋白、钙均低于存活组,差异均有统计学意义(P<0.05)。logistic回归结果显示,铁蛋白(OR=2.282,P=0.014)和磷(OR=2.075,P=0.023)水平升高均为影响MHD患者预后的独立风险因素,而血红蛋白(OR=0.969,P=0.030)、白蛋白(OR=0.848,P=0.007)、钙(OR=0.148,P=0.041)水平升高均为保护因素。ROC曲线,结果显示,外周血铁蛋白、血红蛋白、白蛋白、钙、磷对MHD患者不良预后的曲线下面积(AUC)均>0.65,预测效能较好。根据ROC曲线得出的cut-off值分别为479.09μg/L、113.95 g/L、39.38 g/L、2.24 mmol/L和1.59 mmol/L。结论:外周血铁蛋白、血红蛋白、白蛋白及钙磷代谢指标检测可以用于评估MHD患者预后,是影响MHD患者预后的独立危险因素。Objective:To investigate the prognostic factors of patients with maintenance hemodialysis(MHD)and the predictive value of peripheral blood related indexes.Method:A total of 157 patients with end-stage renal disease who underwent MHD in Yingtan People's Hospital were enrolled as the research objects between January 2022 and January 2023.As of December 2023,patients were divided into survival group and death group according to survival status.The clinical data in survival group and death group were compared.The risk factors of prognosis in MHD patients were analyzed by logistic regression analysis.The evaluation value of peripheral blood ferritin,hemoglobin,albumin,calcium and phosphorus for adverse prognosis was analyzed by receiver operating characteristic(ROC)curves.Result:There were 120 cases in survival group and 37 cases in death group.The dialysis time of the death group was longer than that of the survival group,the death group had higher levels of ferritin and phosphorus,and lower levels of hemoglobin,albumin,and calcium compared to the survival group,the differences were statistically significant(P<0.05).The results of logistic regression analysis showed that ferritin(OR=2.282,P=0.014)and phosphorus(OR=2.075,P=0.023)level increase were independent risk factors of prognosis in MHD patients,while hemoglobin(OR=0.969,P=0.030),albumin(OR=0.848,P=0.007),calcium(OR=0.148,P=0.041)level increase were protective factors.The results of ROC curves analysis showed that the area under the curve(AUC)values of ferritin,hemoglobin,albumin,calcium and phosphorus for predicting poor prognosis of MHD patients were all>0.65,showing good predictive efficiency.According to ROC curves,cut-off values of the five indexes were 479.09μg/L,113.95 g/L,39.38 g/L,2.24 mmol/L and 1.59 mmol/L,respectively.Conclusion:Peripheral blood ferritin,hemoglobin,albumin and calcium-phosphorus metabolism indexes can be applied to evaluate prognosis of MHD patients,which are independent risk factors of prognosis.

关 键 词：维持性血液透析 铁蛋白 血红蛋白 白蛋白 钙磷代谢 

分 类 号：R692.5[医药卫生—泌尿科学]