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目的研究血液透析患者红细胞分布宽度(RDW)与脑卒中的相关性。方法纳入442例成人血液透析患者进行研究。RDW取值为各次检测结果平均值。活动性出血期及出血后4个月内的RDW被排除。脑卒中经CT或MR证实,分为脑梗死和脑出血。结果中位随访时间50个月,442例血透患者中62例(14.0%)发生脑卒中,包括41例(9.3%)脑梗死和21例(4.8%)脑出血。脑卒中以及脑卒中中的脑梗死患者的RDW比非脑卒中更高[16.5(15.5,18.0)vs 16.0(15.0,17.0)和16.5(15.5,18.0)vs 16.0(15.0,17.0)],差异有统计学意义(P<0.05),但脑出血与非脑卒中组间RDW差异无统计学意义(P>0.05)。经多变量校正后,与第一分位比较,RDW第四分位发生脑梗死的HR值为3.55(95%CI 1.33~9.51),而RDW并非脑出血的独立危险因素。结论RDW升高是血液透析患者发生脑梗死的独立危险因素。
Objective To investigate the relationship between the distribution width of red blood cells (RDW) and stroke in hemodialysis patients. Methods 442 adult hemodialysis patients were included in the study. The RDW value is the average value of each test result. Active bleeding and RDW within 4 months after bleeding were excluded. Stroke confirmed by CT or MR, divided into cerebral infarction and cerebral hemorrhage. Results The median follow-up time was 50 months. Among 442 hemodialysis patients, 62 (14.0%) had stroke, including 41 (9.3%) cerebral infarctions and 21 (4.8%) cerebral hemorrhages. Patients with cerebral infarction in stroke and stroke had higher RDW than non-stroke patients [16.5 (15.5, 18.0) vs 16.0 (15.0, 17.0) and 16.5 (15.5, 18.0 vs 16.0 (15.0, 17.0)], Statistical significance (P <0.05), but there was no significant difference in RDW between cerebral hemorrhage and non-stroke groups (P> 0.05). After multivariable adjustment, the HR of cerebral infarction in the fourth quintile of RDW was 3.55 (95% CI 1.33-9.51) compared with the first quintile, whereas RDW was not an independent risk factor for cerebral hemorrhage. Conclusions Elevated RDW is an independent risk factor for cerebral infarction in hemodialysis patients.