摘要
目的调查透析患者血红蛋白变异性（hemoglobin variability，Hb—Var）的流行病学特征，探讨Hb．Var的可能影响因素，分析其与预后的关系。方法选取北京大学人民医院2009年10月至2010年3月期间进行维持性透析（包括腹膜透析及血液透析）患者178例，用观察期内（入组前6个月）Hb的剩余标准差（residual standard deviation，Res．SD）和围绕目标值分组，分别计算Hb．Var，以心血管事件及全因死亡为观察终点。随访12个月，分析Hb—Var的影响因素及Hb．Var与透析患者预后之间的关系。结果透析患者6个月Hb的Res—SD为（4．74±2．66）g／L，以高波动组及围绕阈值下限波动组为主。重组人红细胞生成素（EPO）剂量的波动及透析方式是Hb—Var的独立危险因素。Kaplan．Meier生存曲线及Cox多元回归分析结果显示Hb．Var与预后无关，Hb累计达标时间是终点事件发生的独立危险因素。结论Hb—var在透析患者中广泛存在，EPO剂量的波动及透析方式影响Hb—Var，Hb累计达标时间是终点事件发生的独立危险因素。
Objective To investigate the epidemiological characteristics of hemoglobin variability （Hb- Var） in dialysis patients, and to explore the factors related to Hb- Var and the relationship between Hb-Var and patients outcomes. Methods The study enrolled 178 hemodialysis and peritoneal dialysis patients in the Department of Nephrology, Peking University People＇s Hospital between October 2009 and March 2010. First six months were observation period, and then followed up for 12 months. The Hb- Var was described by residual standard deviation （Res- SD） and fluctuation across threshold of the Hb level Non- fatal cardiovascular events and mortality were the primary endpoints. Results The Res- SD was （4.74_＋ 2.66） g/L in dialysis patients. Most patients fell into groups of high amplitude （HA） and low amplitude low （LAL）, with frequency of 29.8% and 33.1% respectively. The related factors of Hb- Var were fluctuation of erythropoietin （EPO） dosage and hemodialysis. Kaplan- Meier survival curve and muhivariable adjusted Cox regression indicated that Res-SD had no impact on the primary endpoints. Accumulative time to reach target hemoglobin level was an independent factor related to outcome. Conclusion Hb- Vat occurs commonly in dialysis patients. The fluctuation of EPO dosage and dialysis style increase Hb-Var. Accumulative time to reach target hemoglobin level is an independent factor related to patients outcomes.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2013年第4期253-257,共5页
Chinese Journal of Nephrology
关键词
腹膜透析
血液透析
血红蛋白
变异性
预后
Peritoneal dialysis
Hemodialysis
Hemoglobin
Variability
Prognosis
