红细胞分布宽度及中性粒细胞/淋巴细胞比值对维持性血液透析患者预后的影响

Effects of red blood cell distribution width and neutrophil/lymphocyte ratio on the prognosis of maintenance hemodialysis patients

目的探讨红细胞分布宽度(red blood cell distribution width,RDW)、中性粒细胞/淋巴细胞比值(neutrophils to lymphocytes ratio,NLR)对维持性血液透析(maintenance hemodialysis,MHD)患者预后的影响。方法回顾性分析2017年1月1日~2018年12月31日在蚌埠医学院第一附属医院血液透析中心规律透析3个月以上、病情稳定的终末期肾病(end-stage renal disease,ESRD)患者的临床资料。根据RDW变化分组,分析2组患者一般情况和RDW等血液学指标之间的差异,以是否发生不良事件分组,分析2组患者RDW、NLR等指标之间的差异。利用Kaplan-Meier及COX回归模型分析RDW、NLR能否独立预测MHD患者的预后。结果纳入221例MHD患者,年龄(56.348±13.104)岁,透析龄31.000(8.000,58.850)个月,共发生不良事件68例,其中29例死亡,39例非致命性不良事件。不良事件组时间平均RDW、NLR较无事件生存组高(Z值分别为2.642、5.044,P值分别为0.009、<0.001)。COX回归分析示:时间平均RDW(HR=1.300,95%CI:1.000~1.691,P=0.049),NLR(HR=1.189,95%CI:1.074~1.316,P=0.001)是MHD患者发生不良事件的独立危险因素。结论高时间平均RDW、NLR可独立预测MHD患者不良事件的发生。

Objective To explore the red blood cell distribution width(RDW)and neutrophil/lymphocyte ratio(NLR)on the prognosis of maintenance hemodialysis(MHD)patients.Methods Clinical data of the end-stage renal disease(ESRD)patients treated with regular dialysis for more than 3 months and with stable condition in the Hemodialysis Center of the First Affiliated Hospital of Bengbu Medical College from January 1,2017 to December 31,2018 were retrospectively analyzed.Patients were divided into two groups based on the difference of RDW,and the general conditions and hematological indicators such as RDW were compared between the two groups.Patients were also divided into two groups based on the presence or absence of adverse events,and their RDW and NLR were compared between the two groups.Kaplan-Meier curve and COX regression model were used to analyze RDW and NLR for independent prediction of prognosis in MHD patients.Results A total of 221 MHD patients with the age of 56.3±13.1 years old and dialysis age of 31.0(8.0,58.9)months were included in this study.Adverse events were found in 68 patients,in which 29 cases died and 39 cases had non-fatal events.In the adverse event group,the mean RDW and NLR were higher than those in the non-event and survival group(Z=2.642 and 5.044 respectively;P=0.009 and<0.001 respectively).COX regression analysis showed that time mean RDW(HR=1.300,95%CI:1.000~1.691,P=0.049)and NLR(HR=1.189,95%CI:1.074~1.316,P=0.001)were the independent risk factors for adverse events in MHD patients.Conclusion Higher time mean RDW and NLR can independently predict the occurrence of adverse events in MHD patients.