红细胞分布宽度对维持性血液透析患者预后的影响

目的探讨血液透析（HD）患者红细胞分布宽度（RDW）与死亡风险的相关性。方法HD患者613例，根据RDw正常值范围的界值（15．5％）分成两组，主终点事件是死亡。两组间累计全因死亡风险采用Kaplan．Meier曲线和Cox回归分析。结果613例HD患者，中位随访时间32．8个月（range：3-95．1）。RDW平均值14．3％（9．2％~26．1％）。与RDW〈15．5％组患者比较，RDW≥15．5％组患者的1、3、5年的累积生存率明显降低，分别为8l％、66％、55％，且全因死亡发生率明显高于RDW〈15．5％组（10g．rank=10．12，P〈0．001）。多因素Cox归分析校正多项混杂因素后，发现RDW≥15．5％是HD患者发生死亡的危险因素（HR，1．43；95％CI，1．09-1．82；P=0．021）。结论高RDW可增加维持性血液透析患者的病死率，增加死亡风险。

Objective To explore elevated red blood cell distribution width （RDW） and mortality risk in hemodialysis patients. Methods We recruited 613 patients who underwent hemodialysis from January 2007 to January 2012, categorized according to RDW. Survival was calculated using Kaplan-Meier Method and Cox regression models were used to evaluate the relationship between RDW with ali-cause mortality, initially without adjustment, and subsequently adjusting for several groups of covariates. Results A total of 613 patients had a median follow-up of 32.8 months （ range ： 3-95.1 ） . The mean value of RDW is 14.3% （ 9.2%~26.1% ） . In crude analysis, all-cause mortality were significantly higher in the patients with RDW〉15.5% compared with those in RDW〈15.5% （ log-rank=10.12, P〈0.001 ） . After adjusted by other anemia parameters, the hazard ratio of all-cause mortality in patients with RDW≥ 15.5% was 1.43 E 95% confidence interval （ CI ） ： 1.09-1.82, P=0.021 ] . Conclusions HD patients with RDW level≥ 15.5% were at high risk of all-cause mortality.