维持性血液透析患者微量元素与全血细胞分布宽度相关性分析

Analysis of the Relationship Between the Distribution with of Whole Blood Cells and Micronutrient in Maintenance Hemodialysis Patients

目的:探讨维持性血液透析(maintenance hemodialysis,MHD)患者全血微量元素与红细胞分布宽度(red blood cell distribution width,RDW)之间的关系。方法:采用单中心横断面研究,纳入2019年9月于本中心行规律MHD的患者。收集透析前血液标本和临床数据。根据RDW的中位数将患者分为两组,采用Spearman相关分析和二元logistic回归分析评估与RDW水平相关的因素。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线),评价前述回归中有意义的微量元素对RDW的诊断价值。结果:共纳入154例MHD患者,中位RDW为14.9(14.1±15.9)%。Spearman相关分析表明,RDW与全血铜水平呈正相关,而与其他微量元素无相关。此外,RDW水平也与血清白蛋白、前白蛋白水平和血清铁呈负相关,与白细胞介素-6和C反应蛋白呈正相关。在校正相关因素后,多变量logistic回归分析显示,全血铜>825.35μg/L与低血清铁是RDW≥14.9%的独立影响因素。ROC曲线下面积为0.681(95%CI 0.596~0.765,P<0.001)。结论:较高的全血铜与低血清铁是MHD患者RDW的独立影响因素,全血铜对RDW有一定的预测价值。

Objective:To investigate the relationship between red blood cell width(RDW)and whole blood micronutrient in maintenance hemodialysis(MHD)patients.Methods:A single-center cross-sectional study was conducted in MHD patients in September 2019.Blood samples and clinical data were collected before dialysis.The patients were divided into two groups according to the median of RDW,and the factors associated with RDW were evaluated by Spearman correlation analysis and Binary Logistic Regression analysis.Receiver?Operating Characteristic Curve(ROC curve)was drawn to evaluate the diagnostic value of significant micronutrient in RDW.Results:154 MHD patients were included.The median RDW was 14.9(14.1±15.9)%.RDW was positively correlated with whole blood copper levels,but not with other micronutrient,according to Spearman correlation analysis.In addition,RDW was negatively correlated with Alb,prealbumin and serum iron,and positively correlated with interleukin-6 and c-reactive protein.After adjusting correlative factors,multivariate logistic regression analysis showed that whole blood copper>825.35 g/L and low serum iron were independent influencing factors for RDW≥14.9%.The area under the ROC curve was 0.681(95%CI 0.596~0.765,P<0.001).Conclusion:Higher Whole Blood Copper and lower serum iron are independent influencing factors of RDW in MHD patients.Whole blood copper has a certain predictive value for RDW.