红细胞分布宽度与维持性血液透析患者预后关系的Meta分析

The relationships between erythrocyte distribution width and prognosis of maintenance hemodialysis patients:a Meta-analysis

目的通过Meta分析系统评价红细胞分布宽度(RDW)对维持性血液透析(MHD)患者的预后评估价值,进一步为临床判断提供理论支持。方法检索中国知网、万方数据服务平台、中国生物医学数据库、PubMed、EMbase和The Cochrane Library数据库,全面搜索有关RDW与MHD患者预后关系的前瞻性与回顾性队列研究,检索时限为建库至2022年6月,由两名研究人员按照纳入与排除标准独立进行文献筛选、资料提取,并利用纽卡斯尔-渥太华量表进行质量评价,使用R 4.1.2软件分析数据。结果共纳入13篇队列研究文献,合计113535例MHD患者。RDW与MHD患者预后的关系:当RDW为连续性变量时,RDW每增加1%,全因死亡的风险增加32%(HR=1.32,95%CI:1.23~1.41),心血管疾病死亡风险增加42%(HR=1.42,95%CI:1.25~1.62);RDW为分类变量时,高RDW组全因死亡风险是低RDW组的1.36倍(HR=1.36,95%CI:1.13~1.64),高RDW组心血管疾病死亡风险是低RDW组的1.75倍(HR=1.75,95%CI:1.19~2.56)。结论RDW增加是MHD患者全因死亡风险与心血管疾病死亡风险增加的危险因素,对MHD患者的预后具有重要预测价值。

Objective To evaluate the prognostic value of erythrocyte distribution width(RDW)in maintenance hemodialysis(MHD)patients by Meta-analysis,and to provide theoretical support for clinical judgment.Methods CNKI,Wanfang data,China Biomedical Database,PubMed,EMbase and The Cochrane Library were searched for prospective and retrospective cohort studies on the relationship between RDW and the prognosis of MHD patients.The retrieval time was from the date of datebase creation to June 2022.Literature screening and data extraction were conducted independently by two researchers according to inclusion and exclusion criteria,and quality evaluation was conducted using Newcastle-Ottawa evaluation form.Data was analyzed using R4.1.2 software.Results A total of 13 cohort studies involving 113535 patients with MHD were included.Relationship between RDW and prognosis of in MHD patients:when RDW was a continuous variable,the risk of all-cause death increased by 32%(HR=1.32,95%CI:1.23-1.41)and the risk of cardiovascular disease death increased by 42%(HR=1.42,95%CI:1.25-1.62)for every 1%increase in RDW.When RDW was a categorical variable,the risk of all-cause death was 1.36 times higher in the high RDW group than in the low RDW group(HR=1.36,95%CI:1.13-1.64)and the risk of cardiovascular disease death was 1.75 times higher in the high RDW group than in the low RDW group(HR=1.75,95%CI:1.19-2.56).Conclusion Increased RDW is a risk factor for increased risk of all-cause death and cardiovascular disease death in patients with MHD,and has important predictive value for the prognosis of patients with MHD.