RDW与腹膜透析患者不良心血管事件的相关性分析

Correlation between red cell distribution width with adverse cardiovascular events and death in patients undergoing continuous ambulatory peritoneal dialysis

目的探讨红细胞体积分布宽度(RDW)与持续不卧床腹膜透析患者不良心血管事件和死亡的相关性。方法回顾性分析2012年3月至2018年3月在该院进行腹膜透析置管术的214例终末期肾病(ESRD)患者资料。透析前3个月内测定患者血液RDW,将RDW与患者全因死亡进行受试者工作特征(ROC)分析得出最佳截断值,将患者分为高RDW组(n=70)和低RDW组(n=144)。收集所有患者一般人口学特征资料并进行血液生物化学检查,置管术后采用持续不卧床腹膜透析,观察并记录患者治疗开始时至改变治疗方式或死亡期间心血管不良事件的发生及因心血管疾病导致死亡的情况。结果两组患者舒张压、RDW、血红蛋白(Hb)、清蛋白(ALB)、全段甲状旁腺激素(iPTH)、总胆固醇(TC)、载脂蛋白a(Apo-a)及肾小球滤过率(eGFR)差异有统计学意义(P<0.05);高RDW组患者总内生肌酐清除率(Ccr)明显低于低RDW组,心血管疾病总发生率明显高于低RDW组;高脂血症及动脉粥样硬化发生率明显高于低RDW组(均P<0.05);患者Hb、ALB水平、eGFR及使用铁剂与体内RDW水平呈负相关(P<0.05);患者血清铁蛋白(SF)、Apo-a水平、合并心血管不良事件与体内RDW水平呈正相关(P<0.05);高RDW组全因死亡及因心血管疾病病死率明显高于低RDW组,1、3年及5年生存率均明显低于低RDW组(均P<0.05)。结论RDW可作为预测持续不卧床腹膜透析患者全因死亡及心血管不良事件死亡的指标。

Objective To investigate the correlation between the red cell distribution width(RDW)with the adverse cardiovascular events and death in the patients undergoing continuous ambulatory peritoneal dialysis.Methods The data of 214 patients with end-stage renal disease(ESRD)undergoing the peritoneal dialysis catheterization in this hospital from March 2012 to March 2018 were retrospectively analyzed.Blood RDW was measured within 3 months before dialysis.The best cut-off value was obtained by conducting the ROC analysis of RDW and all-cause death.The patients were divided into the high RDW group(n=70)and low RDW group(n=144).The general demographic data of all patients were collected and blood biochemical examinations were performed,postoperative peritoneal dialysis mode adopted the continuous ambulatory peritoneal dialysis,meanwhile,the occurrence of adverse cardiovascular events and cardiovascular diseases caused death from the treatment beginning to changing the treatment mode or death were also observed and recorded.Results The diastolic blood pressure,RDW,hemoglobin(Hb),albumin(ALB),intact parathyroid hormone(iPTH),total cholesterol(TC),apolipoprotein A(Apo-a)and glomerular filtration rate(eGFR)showed statistically significant difference between the two groups(P<0.05).The total Ccr level of the high RDW group was significantly lower than that of the low RDW group(P<0.05);the overall incidence rate of cardiovascular disease in the high RDW group was significantly higher than that in the low RDW group(P<0.05);the incidence rates of hyperlipidemia and atherosclerosis in the high RDW group were significantly higher than those in the low RDW group(P<0.05).The levels of Hb,ALB,eGFR and ferralia use were negatively correlated with the RDW level in vivo(P<0.05).Serum ferritin(SF),Apo-a levels and complicating cardiovascular adverse events were positively correlated with the RDW level(P<0.05).The all-cause mortality and cardiovascular disease mortality in the high RDW group were significantly higher than those in the low RDW group(P<0.05).The 1-year,3-year and 5-year survival rates in the high RDW group were significantly lower than those in the low RDW group(P<0.05).Conclusion RDW can serve as a indicator for predicting the all-cause death and cardiovascular adverse event death in the patients with continuous ambulatory peritoneal dialysis.