基线和时间依赖血红蛋白水平与中国慢性肾脏病患者主要临床结局的相关性分析  

Association of baseline and time-updated hemoglobin with major clinical outcomes in patients with chronic kidney disease in China

作　　者：杨丽平 张路霞[1,3,4,5,6,7] 高碧霞[1,3,4,5,6] 王芳 赵明辉[1,3,4,5,6] 李深 王晋伟[1,3,4,5] YANG Li-ping;ZHANG Lu-xia;GAO Bi-xia;WANG Fang;ZHAO Ming-hui;LI Shen;WANG Jinwei(Renal Division,Department of Medicine,Peking University First Hospital,Beijing 100034,China;Renal Division,Guang’anmen Hospital of China Academy of Traditional Chinese Medicine Sciences,Beijing 100053,China)

机构地区：[1]北京大学第一医院肾脏内科,北京100034 [2]中国中医科学院广安门医院肾病科,北京100053 [3]北京大学肾脏病研究所,北京100034 [4]国家卫生健康委员会肾脏疾病重点实验室,北京100034 [5]教育部慢性肾脏病防治重点实验室,北京100034 [6]中国医学科学院免疫介导肾病诊治创新单元,北京100730 [7]北京大学健康医疗大数据国家研究院,北京100191

出　　处：《中国实用内科杂志》2024年第12期1018-1025,共8页Chinese Journal of Practical Internal Medicine

基　　金：科技部国家重点研发计划项目(2020YFC2005003);国家自然科学基金项目(82374277,72125009,91846101,81771938,81900665,82003529,82090021);中国科技创新计划2030(2018AAA0102100);密歇根大学卫生系统-北京大学卫生科学中心转化与临床联合研究所(BMU2018JI012,BMU2019JI005);中科院医学科学创新基金(2019-I2M-5-046);北大-百度基金(2019BD017,2020BD004,2020BD005);中央级公益性科研院所基本科研业务费专项(ZZ13-YQ-025)。

摘　　要：目的评价肾性贫血与终末期肾脏病(ESKD)、心血管事件和全因死亡的关系。方法基于中国慢性肾脏疾病(CKD)前瞻性队列研究,共纳入2011年11月至2016年12月,39个分中心,基线数据完整的3413例和具有基线及2次以上年度访视的914例CKD患者作为研究对象。采用多变量Cox比例风险回归模型分别分析基线和时间依赖性血红蛋白(Hb)水平与ESKD、心血管事件和全因死亡的关系。结果在进行多因素校正后,基线Hb(HR=1.14,95%CI 1.08~1.20)和时间依赖性Hb水平(HR=1.51,95%CI 1.35~1.70)均与ESKD风险相关,时间依赖性Hb关联性更强。基线Hb,而非时间依赖性Hb与全因死亡独立相关(HR=1.14,95%CI 1.03~1.25)。基线Hb与充血性心力衰竭风险相关(HR=1.16,95%CI 1.02~1.33)。结论在中国CKD1~4期患者中,较低的基线和时间依赖性Hb水平均与ESKD风险增加独立相关。贫血与全因死亡以及充血性心衰的关联仅在单次评价Hb时发现,长期暴露的作用仍需要进一步研究。Objective To evaluate the association of baseline and time-updated hemoglobin(Hb)with end-stage kidney disease(ESKD),all-cause mortality,and cardiovascular events.Methods This study was based on the Chinese Cohort Study of Chronic Kidney Disease.A total of 3413CKD patientswith complete baseline dataand 914 CKD patients with baseline data and at least 2 follow-up records each yearfrom 39 centers between Nov.2011 and Oct.2016 were included as the research subjects.Multivariable Cox proportional hazards regression models were applied to analyze the association of baseline and time-updated Hbwith the occurrence of ESKD,cardiovascular events and all-cause mortality.ResultsAfter multivariable adjustment,both baseline(HR=1.14,95%CI 1.08-1.20)and time-updated Hb(HR=1.51,95%CI 1.35-1.70)were associated with the risk of ESKD,and the association of timeupdated Hb was more significant.Only baseline Hb,not time-updated Hb,was associated with all-cause death(HR=1.14,95%CI 1.03-1.25).Baseline Hb was associated with the risk of congestive heart failure(HR=1.16,95%CI 1.02-1.33).ConclusionIn Chinese patients with stage 1-4 CKD,low baseline and time-updated Hb level is independently associated with the increased risk of ESKD.The association of anemia with congestive heart failure and all-cause mortality is only significant in single Hb evaluation,and the effects of long-term exposure need further study.

关 键 词：慢性肾脏病 贫血 终末期肾脏病 心血管疾病 全因死亡 队列研究 

分 类 号：R556.9[医药卫生—血液循环系统疾病]