腹膜透析患者血红蛋白波动与其心血管预后

The relationship between hemoglobin variation and cardiovascular prognosis in peritoneal dialysis patients

目的了解腹膜透析患者血红蛋白波动与其心血管预后关系。方法搜集2006年5月1日～2011年9月1日在上海仁济医院开始透析并持续腹膜透析3个月及以上患者的基线及随访期间的临床及实验室检查资料,随访截止日期为2011年12月1日。按血红蛋白波动绝对值、血红蛋白波动趋势及红细胞生成素反应性对血红蛋白波动进行分组并进行统计分析。结果 398名患者中,最终333名纳入分析。在血红蛋白波动绝对值分组中,透析开始3个月时血红蛋白升高<10g/l组新患心血管病(cardiovascular disease,CVD)人数百分比(27.2%vs.2.2%,P<0.05)及CVD事件人时发病率显著高于≥10g/l组(1/76.2 vs.1/120.1次/病人月)。在血红蛋白波动趋势分组中,透析3个月血红蛋白始终较高组(HH组)既往患CVD再发CVD事件的人数百分比显著高于其他3组。在红细胞生成素反应性分组中,红细胞生成素反应性<0.01g/l/100u的患者CVD事件人时发病率(1/59.2次/患者月)明显高于其他组。结论腹膜透析患者血红蛋白波动影响其心血管预后。研究提示对于既往无CVD合并症的患者,应及时纠正贫血,而对于既往有CVD患者,血红蛋白水平不宜长期维持在高水平。在临床中需密切注意红细胞生成素低反应的患者可能更易出现CVD事件。此结论推广还需进一步证实。

Objective To understand the effect of hemoglobin （Hb） fluctuation on cardiovascular prognosis in peritoneal dialysis （PD） patients. Methods We recruited clinical and laboratory data of the PD patients treated in Division of Nephrology, Renji Hospital for more than 3 months in the period from May 1st, 2006 to Sept. 1st, 2011. They were followed up until Dec. 1st, 2011. The absolute value of lib variation, the trend of Hb variation, and the response of Hb variation to erythropoietin （EPO） were used to analyze the effect of Hb variation on cardiovascular prognosis in PD patients. Results After PD for 3 months, Hb variation could be analyzed in 333 of the 398 PD patients. In patients with the increase of absolute Hb value of 〈10g/L and 〉10g/L, the incidence of new cardiovascular disease （CVD） patients was 27.2% and 12.2% （P〈0.05）, respectively, and the presence of CVD event was 1/76.2 patients/month and 1/120.1 patients/month, respectively. The percentage of recurrent CVD events in the 3 months of PD was significantly higher in the patients with sustained higher Hb than those in the other 3 Hb variation trend groups （66.7%, P〈0.05）. The presence of CVD event was 1/59.2 patients/month in patients with Hb response of 〈0.01g/L/100IU to EPO treatment, significantly higher than that in the patients with higher Hb response to EPO treatment. Conclusions Hb variation affected the cardiovascular prognosis in PD patients. Our findings suggest that anemia should be treated in PD patients without history of CVD events, and Hb should not be maintained at a higher level in patients with the history CVD events. CVD events occurred more likely in PD patients with lower response to EPO. However, further investigations need to be conducted to confirm our findings.