红细胞分布宽度联合碱性磷酸酶对维持性血液透析患者心血管事件的预测价值

Predictive value of red cell distribution width combined with alkaline phosphatase on cardiovascular events in maintenance hemodialysis patients

目的探讨红细胞分布宽度(RDW)联合碱性磷酸酶(ALP)对维持性血液透析(MHD)患者心血管事件的预测价值。方法选取2019年1月—2021年12月江苏省太仓市第一人民医院MHD患者262例为研究对象,最终纳入245例患者。以是否发生CVE将患者分为CVE组44例和非CVE组201例。比较2组患者临床资料、相关实验室指标;RDW、ALP与实验室指标的相关性采用Pearson相关分析;MHD患者发生CVE的危险因素采用Cox回归分析;采用受试者工作特征(ROC)曲线分析RDW、ALP以及RDW-ALP联合检测MHD患者发生CVE的曲线下面积(AUC)。结果纳入MHD患者中,发生CVE为44例,占17.96%。2组在年龄、是否合并透析前高血压、是否合并糖尿病、血红蛋白、白蛋白、超敏C反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-proBNP)、血磷、RDW、ALP方面比较,差异有统计学意义(P<0.05)。年龄增高(HR=1.101,95%CI:0.998~1.154,P=0.02)、合并糖尿病(HR=1.212,95%CI:1.007~1.458,P=0.012)、RDW升高(HR=1.014,95%CI:0.874~1.383,P=0.03)、ALP升高(HR=1.024,95%CI:1.006~1.042,P=0.008)、NT-proBNP上升(HR=1.15,95%CI:1.05~1.67,P=0.041)是MHD患者CVE发生的独立危险因素。RDW预测患者发生CVE的AUC为0.792,ALP的AUC为0.737,RDW-ALP联合的AUC为0.866。RDW-ALP联合预测的AUC大于RDW、ALP单独预测,差异有统计学意义(P<0.05)。结论RDW、ALP是预测MHD患者发生CVE的有效指标,两者联合检测可提高预测价值。

Objective To investigate the predictive value of red cell distribution width(RDW)combined with alkaline phosphatase(ALP)for cardiovascular events in patients with maintenance hemodialysis(MHD).Methods A total of 262 MHD patients from Taicang First People′s Hospital in Jiangsu Province from January 2019 to December 2021 were selected as the study objects,and 245 patients were eventually included.The patients were divided into CVE group(44 cases)and non-CVE group(201 cases).Clinical data and related laboratory indexes were compared between the two groups;the correlations of RDW and ALP with laboratory indexes were analyzed by Pearson correlation analysis;the risk factors of CVE in MHD patients were analyzed by Cox regression;the receiver operating characteristic(ROC)curves were used to analyze RDW,ALP and RDW-ALP combined to detect the area under the curve(AUC)of CVE in MHD patients.Results Among the included MHD patients,CVE occurred in 44 cases,accounting for 17.96%.There were statistically significant differences in age,presence or absence of combining with pre-dialysis hypertension,presence or absence of complicating with diabetes,hemoglobin,albumin,high-sensitivity C-reactive protein(hs-CRP),N-terminal pro-B-type natriuretic peptide(NT-proBNP),blood phosphorus,RDW and ALP between the two groups(P<0.05).Increased age(HR=1.101,95%CI,0.998 to 1.154,P=0.02),combined with diabetes(HR=1.212,95%CI,1.007 to 1.458,P=0.012),increased RDW(HR=1.014,95%CI,0.874 to 1.383,P=0.03),increased ALP(HR=1.024,95%CI,1.006 to 1.042,P=0.008),increased NT-pro BNP(HR=1.15;95%CI,1.05 to 1.67;P=0.041)were independent risk factors for CVE in MHD patients.AUC predicted by RDW was 0.792 for CVE,0.737 for ALP,and 0.866 for RDW-ALP.The AUC of RDW-ALP combined prediction was significantly greater than that of RDW and ALP alone(P<0.05).Conclusion RDW and ALP are effective indicators for predicting CVE in MHD patients,and their combined detection can improve the predictive value.