红细胞分布宽度升高是血液透析患者心血管死亡的独立危险因素

Higher red blood cell distribution width is the independent risk factor for cardiovascular mortality in hemodialysis patients

目的在心血管疾病（cardiovascular disease,CVD）患者中,红细胞分布宽度（red blood cell distribution width,RDW）与心血管死亡及全因死亡相关。但在血液透析患者中,RDW与CVD及预后的相关性尚无报道。因此,本研究旨在探讨RDW对血液透析患者心血管事件发生及死亡的影响。方法纳入广东省人民医院血液透析患者共286名,随访时间为2009年1月1日~2014年12月31日。记录一般资料、实验室检查等,终点是心血管事件、心血管死亡及全因死亡。结果平均随访时间57.2月,286名血液透析患者中96人（33.5%）死亡,57人（19.9%）发生心血管死亡,119人（42%）发生心血管事件。多因素生存分析,经校正后,RDW仍是全因死亡、心血管死亡及心血管事件的独立危险因素,危险比值分别为1.36（95%CI 1.17~1.58,P〈0.001）、1.38（95%CI 1.16~1.64,P〈0.001）和1.22（95%CI1.06~1.40,P=0.006）。结论 RDW升高是血液透析患者全因死亡及心血管死亡和心血管事件的独立危险因素。

Objectives Studies have found that red blood cell distribution width（RDW） is a powerful predictor for all- cause mortality and cardiovascular mortality in a variety of primary cardiovascular disease（CVD） patients. However, no data were available about the association between RDW and cardiovascular events and their outcomes in maintenance hemodialysis（MHD） patients. We have conducted a study to correlate RDW with CVD and all- cause mortality in MHD patients. Methods Baseline clinical data and RDW were collected from 286 MHD patients treated in the Hemodialyis Center of Guangdong General Hospital in the period from Jan. 1, 2009 to Dec. 31, 2012. The incidences of CVD events, all-cause death and CVD death were recorded. Results In a median follow-up period of 57.2 months 96（33.5%） died of all-cause mortality,in which 57（19.9%） died of CVD, and new-onset CVD events happened in 119（42 %） cases. In a multivariate Cox proportional hazard model, RDW remained an independent risk factor for all- cause mortality, CVD mortality and CVD events after adjustment of multi-factors, and the adjusted hazard ratio for all-cause mortality, CVD mortality and CVD events was 1.36（95% CI 1.17~1.58）, 1.38（95% CI 1.16~1.64）, and 1.22（95%CI 1.06~1.40）, respectively. Conclusion Higher RDW was independently associated with the increased risk of all-cause mortality, CVD mortality and CVD events in MHD patients.