摘要
目的探讨维持性血液透析患者血红蛋白变异性和新发心脑血管事件及动静脉内瘘血栓形成发生率的关系。方法收集2011年1月在北京大学第三医院肾内科血液透析中心维持性血液透析患者临床及化验资料完整者116例,随访从2011年7月--2013年12月结束。男性62例,女性54例,平均年龄63±13岁,随访记录至2013年12月时上述患者发生心脑血管并发症、动静脉内瘘血栓形成以及全因死亡的终点事件,评估计算每位患者入选前半年血红蛋白的变异性（用患者的血红蛋白变异系数=血红蛋白标准差（SD）/平均数×100%来计算）与心脑血管事件、动静脉内瘘血栓形成以及死亡发生率之间的关系,每位患者计算Charlson合并症评分。结果随访过程中全因死亡19例,心血管死亡9例,26例患者发生心脑血管事件,11例发生动静脉内瘘血栓形成行手术治疗好转,Kaplan-Meier生存曲线分析血红蛋白变异系数大于6.2%及血清白蛋白小于38.1g/L其心脑血管事件及内瘘堵塞的发生率明显增加,Cox回归分析表明血红蛋白变异系数〉6.2%、血清白蛋白〈38.1g/L,Charlson合并症评分是新发心脑血管事件及内瘘堵塞的独立危险因素。结论血液透析患者的血红蛋白变异性和低蛋白血症是新发心脑血管事件、动静脉内瘘血栓形成的独立危险因素。
Objective To investigate the relationship between hemoglobin variation and incidents of cardio- cerebro-vascular events and thrombosis in arteriovenous fistula in maintenance hemodialysis （MHD） patients. Methods A total of 116 MHD patients treated in Peking University Third Hospital in Jan., 2011 were en- rolled in this study, and were followed up from July, 2011 to Dec, 2013 or to the end-point events including cardio-cerebro vascular events, arteriovenous fistula thrombosis, and all-cause mortality. Hemoglobin varia- tion was defined as the coefficient of variation of mean hemoglobin in the six months before follow-up period. We then analyzed the relationship between hemoglobin variation and end-point events. Results Cardio-cere- bro-vascular events, arteriovenous fistula thrombosis, and all-cause mortality occurred in 56 patients during the follow-up period. All-cause mortality happened in 19 patients, cardiovascular mortality in 9 patients, car- dio-cerebro-vascular events in 26 patients, and arteriovenous fistula thrombosis in 11 patients. Kaplan-Meier survival curve analysis indicates that the incidences of cardio-cerebra-vascular events and arteriovenous fistu- la thrombosis increase in patients with higher hemoglobin variation （coefficient of variation of hemoglobin 〉 6.2%） and lower serum albumin （〈38.1g/L）. Cox regression analysis shows that coefficient of variation of hemoglobin 〉6.2%, serum albumin 〈38.1g/L and Charlson eomorbidity index are the independent risk factors for cardio-cerebro-vascular events and arteriovenous fistula thrombosis. Conclusions Hemoglobin variation and low serum albumin are associated with cardio-cerebro-vascular events and arteriovenous fistula thrombosis in MHD patients.
出处
《中国血液净化》
2015年第6期337-341,共5页
Chinese Journal of Blood Purification
