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目的探讨红细胞分布宽度(red blood cell distribution width,RDW)与腹膜透析(peritoneal dialysis,PD)患者心血管事件发生的相关性。方法行腹膜透析置管术并规律随访的维持性PD患者138例,根据RDW值分为RDW<15%组104例和RDW≥15%组34例,比较2组一般资料、透析相关指标、实验室指标和心血管事件发生率,分析RDW与各指标的相关性,采用Kaplan-Meier法绘制生存曲线,采用Log-Rank法比较2组心血管事件发生率,采用Cox比例风险回归模型分析RDW升高对心血管事件发生的影响。结果13例患者发生心血管事件,RDW≥15%组6例,RDW<15%组7例;2组透析龄、血压、总尿素清除指数、24h尿量、估算肾小球滤过率及贫血治疗药物使用比例比较差异均无统计学意义(P>0.05);RDW≥15%组血清C反应蛋白[3.05(0.79,15.30)mg/L]、甲状旁腺素[260.0(192.7,352.6)ng/L]水平高于RDW<15%组[2.15(1.00,6.50)mg/L、200.7(118.0,319.7)ng/L](P<0.05),血白蛋白[30.65(27.4,32.8)g/L]、前白蛋白[(299±96)g/L]、三酰甘油[1.24(0.72,1.50)mmol/L]、转铁蛋白饱和度[27.9(16.4,43.6)%]低于RDW<15%组[32.3(29.25,34.95)g/L、(346±86)g/L、1.42(1.12,1.84)mmol/L、37.8(23.3,57.2)%](P<0.05);RDW与白蛋白、前白蛋白、三酰甘油呈负相关(r=-0.258,P=0.002;r=-0.236,P=0.005;r=-0.194,P=0.023),与C反应蛋白呈正相关(r=0.174,P=0.041);RDW≥15%组心血管事件发生率(17.6%)高于RDW<15%组(6.7%)(P<0.01);Cox生存分析显示,RDW升高是PD患者心血管事件发生的独立危险因素(HR=1.702,95%CI:1.051~2.756,P=0.030)。结论 RDW升高可作为PD患者心血管事件发生的独立风险预测因子,评估PD患者心血管事件的发生。
Objective To investigate the relationship between red blood cell distribution width (RDW) and cardiovascular events in patients with peritoneal dialysis (PD). Methods One hundred and thirty-eight patients with maintenance PD undergoing peritoneal dialysis and regular follow-up were divided into RDW (n = 104) and RDW≥15% (n = 34) according to the RDW value. The general data, dialysis-related indicators The incidence of cardiovascular events, the incidence of cardiovascular events and RDW analysis of the correlation between the indicators using Kaplan-Meier survival curve was drawn, the use of Log-Rank comparison of two groups of cardiovascular events, using Cox proportional hazards regression model analysis of RDW High impact on cardiovascular events. Results Thirteen patients had cardiovascular events. Six patients with RDW≥15%, seven patients with RDW <15%, two patients with dialysis age, blood pressure, total urea clearance index, 24h urine output, glomerular filtration rate and anemia (P> 0.05). Serum C-reactive protein [3.05 (0.79, 15.30) mg / L], parathyroid hormone [260.0 (192.7,352.6) ng / L] was significantly higher than that of RDW <15% (2.15 (1.00,6.50) mg / L, 200.7 (118.0,319.7) ng / L] (299 ± 96) g / L], triglyceride [1.24 (0.72,1.50) mmol / L] and transferrin saturation [27.9 (16.4,43.6)%] were lower than those of RDW < (P <0.05). Compared with the control group, the percentages of RDW and white were significantly higher in the 15% group than those in the control group (32.3, 29.25 and 34.95 g / L and 346 ± 86 g / L and 1.42 and 1.83 and 57.2% (R = -0.258, P = 0.002; r = -0.236, P = 0.005; r = -0.194, P = 0.023), which was positively correlated with C-reactive protein (r = 0.174, P = 0.041). The incidence of cardiovascular events in RDW≥15% group was higher than that in RDW≤15% (6.7%) (P <0.01). Cox survival analysis showed that RDW increased in patients with PD Independent risk factors for vascular events (HR = 1.702, 95% CI: 1.051-2.756, P = 0.030) . Conclusions RDW elevation can be used as an independent risk predictor of cardiovascular events in PD patients to assess the incidence of cardiovascular events in PD patients.