红细胞压积与腹膜透析患者心血管事件的相关性

Correlation of hematocrit and cardiovascular events in peritoneal dialysis patients

目的探讨红细胞压积(HCT)与腹膜透析患者心血管事件的相关性。方法回顾性纳入2012年3月19日至2020年7月9日在贵州省人民医院腹膜透析中心行腹膜透析的患者,收集患者人口学资料、基线临床及实验室检查结果,随访至2022年4月8日,主要终点为首次发生心血管事件。根据基线HCT三分位数将患者分为HCT≤26.6%、>26.6%~32.4%和>32.4%三组。比较三组实验室指标以及心血管事件发生情况;采用Kaplan-Meier生存曲线、Cox比例风险回归模型及敏感性分析研究HCT对心血管结局的影响;采用受试者工作特征(ROC)曲线分析HCT对腹膜透析患者发生心血管事件的预测价值。结果共860例腹膜透析患者入选该研究,其中男494例(57.4%),女366例(42.6%),年龄(41.5±15.0)岁。HCT≤26.6%组287例,HCT>26.6%~32.4%组289例,HCT>32.4%组284例。共有265例(30.8%)患者在随访期间首次发生心血管事件,HCT≤26.6%、26.6%~32.4%、>32.4%组心血管事件发生率分别为36.2%(104/287)、34.3%(99/289)和21.8%(62/284),差异有统计学意义(P<0.001)。多因素Cox比例风险回归模型分析结果显示,HCT降低是心血管事件发生的危险因素,与HCT>32.4%相比,HCT≤26.6%组心血管事件的发生风险增加了50.7%(以HCT>32.4%为参照,HCT 26.6%~32.4%:HR=1.444,95%CI:1.029~2.028,P=0.034;HCT≤26.6%:HR=1.570,95%CI:1.096~2.250,P=0.014)。在敏感性分析中,以肾移植为竞争事件,与HCT≤26.6%组相比,HCT>32.4%组发生心血管事件的风险较低[亚分布风险比(SHR)=1.413,95%CI:1.006~1.990,P=0.046]。Kaplan-Meier生存分析结果显示,与其他两组相比,HCT≤26.6%组患者无心血管事件生存率较低(log-rankχ^(2)=9.722,P=0.008);ROC曲线分析结果显示,HCT预测腹膜透析患者发生心血管事件的曲线下面积为0.583(95%CI:0.542~0.623,P<0.001),灵敏度为40.6%,特异度为75.1%。结论腹膜透析患者低水平的HCT与心血管事件发生风险增加相关。

Objective To investigate the correlation between hematocrit(HCT)and cardiovascular events in peritoneal dialysis(PD)patients.Methods Patients undergoing maintenance PD in the PD center of Guizhou Provincial People′s Hospital from March 19,2012 to July 9,2020 were included.Demographic,baseline clinical and laboratory data of the patients were collected and patients were followed up until April 8,2022.The primary endpoint was the first occurrence of a cardiovascular event.According to the tertiles of baseline HCT,the patients were divided into group Q1(HCT≤26.6%),group Q2(HCT>26.6%-32.4%),and group Q3(HCT>32.4%).Laboratory indexes and cardiovascular events were compared among the three groups.Kaplan-Meier survival curve,Cox regression analysis and sensitivity analysis were used to analyze the effect of HCT on cardiovascular outcomes.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of HCT for cardiovascular events in PD patients.Results A total of 860 PD patients were included,including 494 males(57.4%)and 366 females(42.6%),with a mean age of(41.5±15.0)years.There were 287 cases in group Q1,289 cases in group Q2,and 284 cases in group Q3,respectively.A total of 265(30.8%)patients experienced first cardiovascular events during the follow-up period.The incidence of cardiovascular events in groups Q1,Q2 and Q3 was 36.2%(104/287),34.3%(99/289),and 21.8%(62/284),respectively,with a statistically significant difference(P<0.001).The incidence of cardiovascular events decreased with the increase of HCT.Multivariate Cox proportional hazards regression model analysis showed that decreased HCT was a risk factor for cardiovascular events.Compared with group Q3,the risk of cardiovascular events in group Q1 increased by 50.7%(group Q2:HR=1.444,95%CI:1.029-2.028,P=0.034;group Q1:HR=1.570,95%CI:1.096-2.250,P=0.014).In the sensitivity analysis,using kidney transplantation as the competition event,the risk of cardiovascular events was lower in group Q3 than that in group Q1(subdistributional HR=1.413,95%CI:1.006-1.990,P=0.046).Kaplan-Meier survival curve showed that compared with the other two groups,the cardiovascular events-free survival rate of patients in group Q1 was significantly lower(log-rankχ^(2)=9.722,P=0.008).ROC analysis showed that the area under the curve(AUC)of HCT for predicting cardiovascular events in PD patients was 0.583(95%CI:0.542-0.623,P<0.001),with the sensitivity of 40.6%and the specificity of 75.1%.Conclusion Low-level HCT is associated with an increased risk of the first cardiovascular event in PD patients.