中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2013年
4期
253-257
,共5页
腹膜透析%血液透析%血红蛋白%变异性%预后
腹膜透析%血液透析%血紅蛋白%變異性%預後
복막투석%혈액투석%혈홍단백%변이성%예후
Peritoneal dialysis%Hemodialysis%Hemoglobin%Variability%Prognosis
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.
目的 調查透析患者血紅蛋白變異性(hemoglobin variability,Hb-Var)的流行病學特徵,探討Hb-Var的可能影響因素,分析其與預後的關繫.方法 選取北京大學人民醫院2009年10月至2010年3月期間進行維持性透析(包括腹膜透析及血液透析)患者178例,用觀察期內(入組前6箇月)Hb的剩餘標準差(residual standard deviation,Res-SD)和圍繞目標值分組,分彆計算Hb-Var,以心血管事件及全因死亡為觀察終點.隨訪12箇月,分析Hb-Var的影響因素及Hb-Var與透析患者預後之間的關繫.結果 透析患者6箇月Hb的Res-SD為(4.74±2.66) g/L,以高波動組及圍繞閾值下限波動組為主.重組人紅細胞生成素(EPO)劑量的波動及透析方式是Hb-Var的獨立危險因素.Kaplan-Meier生存麯線及Cox多元迴歸分析結果顯示Hb-Var與預後無關,Hb纍計達標時間是終點事件髮生的獨立危險因素.結論 Hb-Var在透析患者中廣汎存在,EPO劑量的波動及透析方式影響Hb-Var,Hb纍計達標時間是終點事件髮生的獨立危險因素.
목적 조사투석환자혈홍단백변이성(hemoglobin variability,Hb-Var)적류행병학특정,탐토Hb-Var적가능영향인소,분석기여예후적관계.방법 선취북경대학인민의원2009년10월지2010년3월기간진행유지성투석(포괄복막투석급혈액투석)환자178례,용관찰기내(입조전6개월)Hb적잉여표준차(residual standard deviation,Res-SD)화위요목표치분조,분별계산Hb-Var,이심혈관사건급전인사망위관찰종점.수방12개월,분석Hb-Var적영향인소급Hb-Var여투석환자예후지간적관계.결과 투석환자6개월Hb적Res-SD위(4.74±2.66) g/L,이고파동조급위요역치하한파동조위주.중조인홍세포생성소(EPO)제량적파동급투석방식시Hb-Var적독립위험인소.Kaplan-Meier생존곡선급Cox다원회귀분석결과현시Hb-Var여예후무관,Hb루계체표시간시종점사건발생적독립위험인소.결론 Hb-Var재투석환자중엄범존재,EPO제량적파동급투석방식영향Hb-Var,Hb루계체표시간시종점사건발생적독립위험인소.
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 multivariable 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-Var 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.
