维持性血液透析患者红细胞分布宽度与蛋白质能量消耗的相关性研究

Study on the correlation between red blood cell volume distribution width and protein energy wasting in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者红细胞分布宽度(RDW)与蛋白质能量消耗(PEW)之间的关系。方法采用多中心横断面研究,收集2018年6-8月贵州省8家血液透析中心MHD患者的一般资料、实验室指标,同时进行物理测量及人体成分分析。根据血常规中RDW的四分位间距将研究对象分为4组,比较组间各指标的差异,采用Logistic回归分析RDW与PEW发病的关系,同时应用ROC曲线评估RDW对MHD患者PEW的预测价值。结果共纳入资料完整的研究对象594例,按RDW四分位分组(Q1、Q2、Q3、Q4)。通过Logistic回归分析,在未校正模型中,Q4组MHD患者的PEW发病风险为Q1组患者的2.583倍(95%CI 1.588~4.202, P<0.001);在校正年龄、性别、糖尿病、透析龄、血红蛋白、血磷、丙氨酸氨基转移酶、天冬氨酸氨基转移酶的模型中,RDW与MHD患者PEW发病风险仍有关,Q4组PEW发病风险为Q1组患者的2.197倍(95%CI 1.306~3.698, P<0.005)。采用受试者工作特征曲线(ROC曲线)分析,RDW对MHD患者PEW发病最佳预测阈值为15.6%,灵敏度、特异度分别为40.35%、78.72%,曲线下面积为0.611(95%CI 0.570~0.650,P<0.0001)。结论 RDW与MHD患者PEW的发生有关,对MHD患者PEW发病有预测价值。

Objective To study the relationship between red blood cell volume distribution width(RDW)and protein energy wasting(PEW)in maintenance hemodialysis(MHD)patients. Methods A multicenter cross-sectional study was conducted in eight hemodialysis centers of Guizhou province in 2018.Clinical data,laboratory values,physical parameters and body composition data of MHD patients were collected. According to the quartile of RDW,the patients were divided into four groups. The differences in the indexes among the 4 groups were compared.Logistic regression models were used to analyze the relationships between RDW and the occurance of PEW. The receiver operating characteristic curves(ROC)was applied to evaluate the predictive power of RDW for PEW. Results Totally 594 MHD patients were enrolled and were divided into 4 groups,value according to RDW quartile(Q1,Q2,Q3 and Q4). Logistic regression analysis showed that the occurance of PEW was correlated with RDW in MHD patients. The risk of PEW in MHD Q4 group was 2.583 times higher than that of the Q1 group(95%CI 1.588-4.202, P<0.001). After adjustment for patients’ age, gender, DM history,dialysis age,hemoglobin, serum phosphorus, serum alanine aminotransferase and aspartate aminotransferase,the risk of Q4 group was 2.197 fold higher than that of Q1 group(95%CI 1.306-3.698, P<0.005). Recover operating characteristic(ROC)analysis showed that the optimal threshold for predicting PEW risks in MHD patients was 15.6% with a sensitivity and specificity of 40.35% and78.72% respectively and the area under curve was 0.611(95%CI 0.570-0.650,P<0.0001). Conclusions For MHD patients,RDW is associated with the occurance of PEW and has the value for PEW.