血红蛋白水平变异性与肾性贫血患者反复输血治疗效果的关系

Relationship between Hemoglobin Level Variability and Effect of Repeated Blood Transfusion Therapeutic in Patients with Renal Anemia

目的:观察肾性贫血患者血红蛋白(Hb)水平的变异性,并分析其与患者反复输血治疗效果的关系。方法:采用回顾性队列研究和倾向性评分匹配方法,将2018年5月至2021年5月常州市第二人民医院接受反复输血治疗有效的60例肾性贫血患者作为有效组;收集同期医院接受反复输血治疗无效的153例肾性贫血患者,采用倾向性评分匹配法,将反复输血治疗有效与无效的患者组成1∶1配对进行分析;查阅两组患者病历资料、实验室指标;记录患者6个月内的Hb水平(1次/月),根据Hb水平计算患者Hb残余标准差(Res-SD)评估患者Hb水平变异性;分析Hb水平变异性与肾性贫血患者反复输血治疗效果的关系。结果:经倾向性评分匹配后,两组患者年龄、性别、透析龄、BMI等基线资料比较差异无统计学意义(P> 0.05);无效组患者血清白蛋白、转铁蛋白水平均明显低于有效组(P<0.05);观察期1和2个月时,两组患者Hb水平比较,差异无统计学意义(P> 0.05);无效组患者3、5和6个月时Hb水平明显低于有效组,4个月时Hb水平明显高于有效组(P<0.05);无效组男性患者、女性患者Res-SD分别明显高于有效组男性患者、女性患者(P<0.05)。经logistics回归分析结果显示,Hb水平变异性(Res-SD)高是肾性贫血患者反复输血治疗无效的危险因素(OR> 1,P<0.05);绘制决策曲线,结果显示,当高风险阈值为0.0-1.0时,Res-SD预测男性肾性贫血患者、女性肾性贫血患者的净受益率均大于0,有临床意义,且高风险阈值在上述范围内取值越小,净受益率越大。结论:肾性贫血患者反复输血治疗效果可能与Hb水平变异性有关。

Objective:To observe the variability of hemoglobin(HB)level in patients with renal anemia,and to analyze its relationship with effect of repeated blood transfusion therapeutic in patients.Methods:A retrospective cohort study and propensity score matching method were used,60patients with renal anemia who had effective treatment with repeated blood transfusion in Changzhou No.2People's Hospital from May2018to May2021were retrospectively analyzed and set as the effective group;153patients with renal anemia who had ineffective treatment with repeated blood transfusion in the hospital in the same period were collected and set as the ineffective group,the propensity score matching method was used,the patients who were effective and ineffective in repeated blood transfusion were matched1∶ 1for analysis;the medical records and laboratory indexes of the two groups were checked;the Hb level of patients within6months(1/month)were recorded,the residual standard deviation(Res-SD)of Hb of patients was calculated according to the Hb level and evaluated the variability of Hb level;the relationship between HB variability level and therapeutic effect of repeated blood transfusion in patients with renal anemia was analyzed.Results:After propensity score matching,there was no statistical significant difference between the two groups in terms of baseline data such as age,sex,dialysis age and BMI(P>0.05).The levels of serum albumin and transferrin of patients in the ineffective group were significantly lower than those of patients in the effective group(P<0.05);at1and2months of the observation period,there was no statistical significant difference in Hb levels of patients in both groups(P<0.05);the Hb level of patients in the ineffective group was significantly lower than that of patients in the effective group at3,5and6months,and significantly higher than that of patients in the effective group at4months(P<0.05);the Res-SD of male patients and female patients in the ineffective group were respectively significantly higher than that of male patients and female patients in the effective group(P<0.05).Logistic regression analysis results showed that high variability of Hb level(Res-SD)was a risk factor for the ineffective treatment of repeated blood transfusion in patients with renal anemia(OR 1,P<0.05);the decision curve results showed that,when the high-risk threshold was0.0-1.0,ResSD predicted the net benefit rates of male and female patients with renal anemia were greater than0,which was clinically significant,the smaller the high-risk threshold in the above range,the greater the net benefit rate.Conclusion:The therapeutic effect of repeated blood transfusion in patients with renal anemia may be related to the variability of Hb level.