肾性贫血变异度对慢性肾脏病患者影响的回顾性分析

Retrospective analysis of renal anemia variability on the patients with chronic kidney disease

目的分析肾性贫血变异度对慢性肾脏病（CKD）患者肾功能进展的影响及不同血红蛋白变异度对患者心血管事件发生率、病死率、再住院率的影响。方法回顾性分析CKDm、V期患者血红蛋白变异度与内生肌酐清除率（Ccr）的相关性，不同血红蛋白变异度组别患者肾功能进展对比，患者心血管事件发生率、病死率、再住院率的对比。结果123例患者血红蛋白的变化值为（20．6±10．7）g／L与Ccr变化值（16．3±4．1）ml／min的相似性距离Pearson相关系数为0．82。经多元协方差分析控制吸烟史、血压、24h尿蛋白定量的影响因素后，CKDⅢ、Ⅴ期血红蛋白波动组患者的Ccr增长均高于血红蛋白稳定组，差异具有统计学意义（F值分别为7．6、9．1、4．3，P〈0．05或P〈0．01）。血红蛋白波动组患者的心血管事件发生率、病死率、再住院率均高于血红蛋白稳定组，差异具有统计学意义（x2值分别为26．9、5．1、10．6，P〈0．05或P〈0．01）。结论血红蛋白的波动加重患者的肾功能进展，增加患者的心血管事件发生率、病死率、再住院率。

Objective To investigate the effect of renal anemia variability on the progression of renal function in patients with chronic kidney disease and hemoglobin variability on the incidence of cardiovascular events, mortality and re-hospitalization rate. Methods one hundred and twenty-three patients with chronic kidney disease with stage Ⅲ-Ⅴ were enrolled in this study. The information of hemoglobin variability, creatinine clearance rate （ Ccr）, renal function, the incidence of cardiovascular events, mortality and rehospitalization rate, the incidence of cardiovascular events, mortality and rehospitalization rate were recorded and analyzed. Results The change of hemoglobin level was （20. 6±10. 7） g/L and Ccr change level was （16. 3±4. 1 ）ml/min in patients, and the pearson correlation coefficient was 0. 82. Multiple covariance analysis showed that Ccr increase level was higher in CKD Ill-V period patients with hemoglobin fluctuations than that of hemoglobin stability patients after adjusting smoking history, blood pressure, 24 h urinary protein quantitative factors （ F = 7. 6,9. 1, 4. 3 ; P〈0. 05 ）. The incidence of cardiovascular events in patients, mortality, rehospitalization rate of hemoglobin wave group were higher than those of hemoglobin stabilizing group（ X2 = 26. 9,5. 1,10. 6,P〈0. 05 or P〈0.01 ） . Conclusion The fluctuation of hemoglobin is able to aggravate quickly of renal function development, increase the incidence, mortality and rehospitalization rate of cardiovascular events.