腹膜透析患者红细胞分布宽度与无创血流动力学及人体成分分析相关性研究

摘要

目的 通过分析腹膜透析患者红细胞分布宽度(red blood cell distribution width,RDW)的改变与无创血流动力学及人体成分分析之间的关系,探讨其在腹膜透析患者病情评估中的应用价值.方法 收集安徽医科大学第一附属医院收治的54例腹膜透析患者作为腹透组,并选择同期在该院体检中心进行体检的健康群众30名作为对照组.分别收集2组RDW、脑钠肽(brain natriuretic peptide,BNP)、N末端脑钠肽前体(N-terminalpro brain natriuretic peptide,NT-proBNP)、无创血流动力学及人体成分分析的数据,分析2组RDW的差异以及腹透组RDW与其它各指标的相关性.结果 腹透组RDW、BNP及NT-proBNP水平较对照组明显升高,差异有统计学意义(P＜0.05);腹透组人体成分分析指标中浮肿指数较对照组升高,体脂肪、身体质量指数、体脂百分比、内脏脂肪面积、体臀脂肪比较对照组降低,差异有统计学意义(P＜0.05).腹透组RDW与BNP及NT-proBNP呈正相关(r1=0.417,r2=0.396,P＜0.01),BNP与NT-proBNP呈正相关(r=0.891,P＜0.01).腹透组RDW与无创血流动力学指标心率、收缩时间比呈正相关(r1=0.343,r2=0.364,P＜0.05),与心脏指数、搏排量、心搏指数、射血分数、速度指数呈负相关(r1=-0.277,r2=-0.399,r3=-0.437,r4=-0.335,r5=-0.338,P＜0.05),与其他指标无相关性.腹透组RDW与人体成分分析指标中浮肿指数呈正相关(r1=0.300,P＜0.05),与其他指标无相关性.多元线性逐步回归模型结果提示腹膜透析患者的浮肿指数是影响RDW的重要因素(t=2.03,P＜0.05).结论 RDW可作为腹膜透析患者不良预后的预测因子,NT-proBNP可代替BNP用于评估腹透患者心功能状态.%Objective To investigate the relationship between the red blood cell distribution width (RDW) with non-invasive hemodynamic monitoring and body composition in peritoneal dialysis (PD) patients,and its applied value in PD patients.Methods Forty-four hospitalized PD patients were retrospectively reviewed,and 30 cases of healthy people served as a control group.The clinical characteristics and parameters such as RDW,brain natriuretic peptide (BNP),N-terminal brain natriuretic peptide (NT-proBNP),non-invasive hemodynamics and body composition were collected.The differences between two groups and the relationship between RDW and other parameters were analyzed.Results The RDW,BNP,and NT-proBNP in PD group were significantly higher than in the control group with the difference being statistically significant (P＜0.01).ECW/TBW was significantly higher,and body fat mass,body mass index,percent body fat,visceral fat area and body-hip ratio were significantly lower in PD group than those in the control group (P＜0.05).RDW in PD group was positively correlated with BNP and NT-proBNP (r1 =0.417,r2 =0.396;P＜0.01),and BNP was positively correlated with NT-proBNP (r =0.891,P＜0.01).RDW was positively correlated with HR and STR (r1 =0.343,r2 =0.364,P＜0.05),and negatively with CI,SV,SI,EF,VI (r1 =-0.277,r2=-0.399,r3 =-0.437,r4 =-0.335,r5 =-0.338;P＜0.05).InPDgroup RDW was positively correlated with ECW/TBW (r1 =0.300,P ＜ 0.05).Multivariate linear regression method showed that RDW was associated with ECW/TBW (t =2.03,P＜0.05).Conclusions RDW can be used as a predictor of poor prognosis in PD patients,and NT-proBNP can be used to assess the cardiac function in dialysis patients instead of BNP.