血红蛋白水平对老年男性住院患者预后影响的回顾性队列研究

Effects of hemoglobin level on prognosis in elderly male inpatients:a retrospective cohort study

目的探讨不同血红蛋白(Hb)水平对老年男性住院患者预后的影响,并分析老年男性肾功能不全患者的最佳Hb区间。方法回顾性分析2008年1月至2010年12月于中国人民解放军总医院国家老年疾病临床医学研究中心住院的1623例老年男性患者的临床资料。根据Hb水平将患者分成4个组:Hb≤110g/L组413例、110g/L<Hb≤120g/L组139例、120g/L<Hb≤130g/L组241例以及Hb>130g/L组830例。根据入院时基线肾功能水平,将患者分为肾功能不全组[eGFR<60ml/(min·1.73m^(2))]357例和肾功能正常组[eGFR≥60ml/(min·1.73m^(2))]1266例。应用SPSS 25.0统计软件进行数据分析。不同Hb水平患者累计生存率及急性心肌梗死发生率差异采用Kaplan-Meier生存曲线分析。相关性分析采用Cox比例风险回归模型。结果在5年随访期内,共有617例(38.0%)患者发生全因死亡,254例(15.7%)患者发生急性心肌梗死。Kaplan-Meier生存曲线分析显示,Hb>130g/L组累计全因死亡率及急性心肌梗死发生率最低,Hb≤110g/L组累计全因死亡率及急性心肌梗死发生率最高,组间两两比较log-rank检验差异均有统计学意义(均P<0.05)。对肾功能不全患者进行Cox比例风险回归分析发现,与Hb≤110g/L组比较,120g/L<Hb≤130g/L组(HR=0.43,95%CI 0.25~0.73;P=0.002)和Hb>130g/L组(HR=0.46,95%CI 0.24~0.87;P=0.017)患者的全因死亡风险显著降低,120g/L<Hb≤130g/L组患者的急性心肌梗死发生风险显著降低(HR=0.31,95%CI 0.14~0.69;P=0.004)。结论老年男性住院患者较高的Hb水平可降低全因死亡率及急性心肌梗死发生率。当患有肾功能不全时,存在最佳Hb水平区间。Hb>120g/L和全因死亡低风险相关,120g/L<Hb≤130g/L和急性心肌梗死低风险相关。

Objective To explore the impact of hemoglobin(Hb)levels on the prognosis of the elderly male inpatients,and to analyze the optimal Hb range for those with renal insufficiency.Methods A retrospective analysis was made of the clinical data of 1623 elderly male patients admitted to the National Geriatric Clinical Medical Research Center of Chinese PLA General Hospital from January 2008 to December 2010.The patients were divided into four groups based on Hb levels:413 in the Hb≤110 g/L group,139 in the 110 g/L<Hb≤120 g/L group,241 in the 120 g/L<Hb≤130 g/L group,and 830 in the Hb>130 g/L group.According to the baseline renal function on admission,the patients were divided into a renal insufficiency group[eGFR<60 ml/(min·1.73m^(2));n=357]and a normal renal function group[eGFR≥60 ml/(min·1.73)m^(2);n=1266].SPSS 25.0 was used for data analysis,and Kaplan Meier survival curve for the difference in cumulative survival rate and cumulative incidence of acute myocardial infarction between the patients with different Hb levels.The correlation analysis was conducted using a Cox proportional risk regression model.Results During the 5-year follow-up,all-cause mortality occurred in 617 patients(38.0%),and acute myocardial infarction in 254(15.7%).Kaplan Meier survival curve analysis showed that the cumulative all-cause mortality rate and incidence of acute myocardial infarction were the lowest in the Hb>130 g/L group,and the highest in the Hb≤110 g/L group.There were statistically significant differences in log rank tests between the two groups(P<0.05 for both).Cox proportional risk regression analysis of patients with renal insufficiency showed that,compared with the Hb≤110 g/L group,the 120g/L<Hb≤130 g/L group(HR=0.43,95%CI 0.25-0.73;P=0.002)and Hb>130 g/L group(HR=0.46,95%CI 0.24-0.87;P=0.017)had a significantly reduced risk of all-cause mortality,and the 120 g/L<Hb≤130 g/L group(HR=0.31,95%CI 0.14-0.69;P=0.004)had a significantly reduced risk of acute myocardial infarction.Conclusion Higher Hb levels in the elderly male inpatients can reduce all-cause mortality and the incidence of acute myocardial infarction.For patients with renal insufficiency,there is an optimal Hb range.Hb>120 g/L is associated with a lower risk of all-cause mortality,and 120 g/L<Hb≤130 g/L with a lower risk of acute myocardial infarction.