红细胞分布宽度与血小板比值对终末期肾病维持性血液透析患者动静脉内瘘失功的预测分析

Predictive analysis of red blood cell distribution width-to-platelet ratio for arteriovenous fistula dysfunction in maintenance hemodialysis patients with end-stage renal disease

目的探讨红细胞分布宽度与血小板比值(RPR)对终末期肾病(ESRD)维持性血液透析患者动静脉内瘘(AVF)失功的预测价值。方法回顾性选取2021年3月至2023年3月于扬州市江都人民医院经自体AVF接受维持性血液透析的105例ESRD患者,于透析开始前测定患者红细胞分布宽度(RDW)及血小板(PLT)水平,计算RPR。对所有患者随访6个月,统计AVF失功情况并分为失功组与未失功组,比较两组透析前RDW、PLT及RPR水平,采用单因素及多因素Logistic回归分析RDW、PLT及RPR与ESRD维持性血液透析患者AVF失功的关系,并绘制受试者工作特征(ROC)曲线,获取曲线下面积(AUC)分析RDW、PLT及RPR对ESRD维持性血液透析患者AVF失功的预测价值。结果105例患者中4例患者因中断治疗、转院剔除。最终入组101例患者,19例发生AVF失功(失功组),发生率为18.81%(19/101);82例AVF功能正常(未失功组)。失功组C反应蛋白、RDW、RPR高于未失功组[(7.36±1.92)mg/L比(5.90±2.40)mg/L、(17.98±2.40)%比(14.96±2.29)%、0.14±0.03比0.11±0.02],糖尿病患者占比高于未失功组,而白蛋白低于未失功组[(33.49±2.78)g/L比(35.01±3.02)g/L],差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,C反应蛋白、RDW、RPR均与ESRD维持性血液透析患者AVF失功有关(P<0.05);ROC曲线分析结果显示,RDW、RPR预测ESRD维持性血液透析患者AVF失功的AUC均大于0.7,且RPR的AUC最高,为0.840(95%CI 0.752~0.928),最佳截断值为0.125,特异度为78.90%,灵敏度为73.20%。结论RDW、RPR均与ESRD维持性血液透析患者AVF失功有关,对AVF失功可能具有一定的预测价值。

ObjectiveTo explore the predictive value of red blood cell distribution width-to-platelet ratio(RPR)on arteriovenous fistula(AVF)dysfunction in maintenance hemodialysis patients with end-stage renal disease(ESRD).MethodsOne hundred and five ESRD patients who underwent maintenance hemodialysis with autologous AVF in Jiangdu People′s Hospital from March 2021 to March 2023 were selected.The red blood cell distribution width(RDW)and platelet(PLT)levels were measured before the start of dialysis,and the RPR was calculated.All patients were followed up for 6 months,and AVF dysfunction was recorded and divided into dysfunction group and non dysfunction group.The levels of RDW,PLT,and RPR before dialysis were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to examine the relationship between RDW,PLT,RPR and AVF dysfunction in ESRD maintenance hemodialysis patients.Receiver operating characteristic(ROC)curves were plotted to obtain the area under the curve(AUC)for RDW analysis the predictive value of PLT and RPR for AVF dysfunction in ESRD maintenance hemodialysis patients.ResultsAmong the 105 patients,4 were excluded due to interruption of treatment and transfer to another hospital.Among the 101 patients ultimately enrolled,19 patients experienced AVF dysfunction(dysfunction group),with an incidence rate of 18.81%(19/101);80 patients did experience AVF dysfunction(non dysfunction group).C-reactive protein,RDW and RPR in the dysfunction group were higher than those in the non dysfunction group:(7.36±1.92)mg/L vs.(5.90±2.40)mg/L,(17.98±2.40)%vs.(14.96±2.29)%,0.14±0.03 vs.0.11±0.02,the proportion of diabetes patients was higher than that in the non dysfunction group,while albumin was lower than that in the non dysfunction group:(33.49±2.78)g/L vs.(35.01±3.02)g/L,with a statistical significant difference(P<0.05).Multivariate Logistic regression analysis showed that C-reactive protein,RDW,RPR were all associated with AVF dysfunction in ESRD maintenance hemodialysis patients(P<0.05).ROC curve was drawn,and the results showed that the AUC of RDW and RPR predicting AVF dysfunction in ESRD maintenance hemodialysis patients was greater than 0.7,and the AUC of RPR was higher,0.840(95%CI 0.752 to 0.928),with an optimal cutoff value of 0.125,specificity of 78.90%,and sensitivity of 73.20%.ConclusionsRDW and RPR are both associated with AVF dysfunction in ESRD maintenance hemodialysis patients,and may have certain predictive value for AVF dysfunction.