维持性血液透析患者红细胞体积分布宽度及相关影响因素研究

摘要

目的:了解维持性血液透析患者的红细胞体积分布宽度(red blood cell distribution width,RDW)及其影响因素.方法:分析2012年1月-3月复旦大学附属中山医院血液净化中心维持性透析患者356例,其中男性226例,女性130例;年龄(59.2±14.5)岁;透析龄(64.3±42.5)个月.收集所有患者的临床病史,并于周中透析前检测血红蛋白(Hb)、RDW、电解质、高敏C反应蛋白(hsCRP)、血清白蛋白、前白蛋白、铁蛋白、转铁蛋白饱和度、甲状旁腺素和N端脑钠肽前体(NT-proBNP),透析前后检测血肌酐、尿素氮并计算单室尿素清除指数(spKt/V).结果:整组患者RDW为(15.14±1.22)% (13.0%~20.4%),中位数14.9%;241例(67.7%)患者RDW水平超过参考值上限.男性患者RDW水平低于女性患者[(15.03±1.11)%比(15.33±1.39)%,P<0.05].Spearman相关分析提示,RDW与年龄(r=0.269,P<0.001)、透析龄(r=0.116,P=0.033)、每周促红细胞生成素(erythropoietin,EPO)剂量(r=0.250,P<0.001)、EPO/Hb比值(r=0.214,P<0.001)、hsCRP(r=0.335,P=<0.001)及NT-proBNP(r=0.133,P=0.027)呈正相关.RDW与血清白蛋白(r=-0.241,P<0.001)、前白蛋白(r=-0.334,P<0.001)呈负相关.多元线性逐步回归模型结果提示,RDW与血清白蛋白呈显著负相关(P<0.01).结论:血液透析患者中RDW水平异常并不少见,且与年龄、透析龄、营养水平、炎性反应状态、心脏功能、EPO剂量及反应等多项临床指标有关.RDW对透析人群预后的预测作用有待于进一步研究证实.%Objective:To investigate the status of red blood cell distribution width (ROW) in hemodialysis (HD) patients and the related factors. Methods: This cross - sectional study was carried out in 356 HD patients(226 male and 130 female) with mean age of (59. 2 ± 14. 5) years and mean dialysis vintage of (64. 3 ± 42. 5) months from Jan 2012 to Mar 2010. Medical history were collected and parameters such as hemoglobin (Hb), RDW, serum electrolytes, high sensitivity C- reactive protein (hsCRP), serum albumin,pre - albumin, ferritin, transferrin saturation , parathyroid hormone (iPTH) and N - terminal brain natriuretic peptide (NT-proBNP) were measured before the mid - week hemodialysis. Serum creatinine and blood urea nitrogen were measured before and after hemodialysis and spKt/V was calculated. Results: The mean level of RDW was (15. 14 + 1.22)% (13. 0%~20. 4% , median 14. 9%) in all patients, of which 241 (67.7%) were abnormal. RDW in male group was significantly lower than that in female group [(15. 03. ±1.11)% vs (15. 33 ± 1. 39) % , P<0. 05]. Spearman correlation analysis showed that RDW was positively correlated with age(r = 0. 269, P<0. 001 ),dialysis vintage (r = 0. 1 16, P = 0. 033) , EPO dose(r = 0. 250, P<0. 001) , EPO/Hb ratio (r = 0. 214, P<0. 001 ) , hsCRP(r = 0. 335 , P = <0. 001) and NT - proBNP(r = 0. 133,P = 0. 027). RDW was negatively correlated with serum albumin(r = - 0. 241 ,P<(). 001 ) and pre - albumin(r = - 0. 334,P<0. 001). Multivariate linear regression model showed that RDW was independently associated with serum albumin and EPO dose (P<0. 01). Conclusions: Abnormality of RDW is common in hemodialysis patients, which may be related to age, dialysis vintage, nutrition status, inflammation, heart disease, EPO dose and response. Further studies are needed to estimate the predictive value of RDW in hemodialysis patients.