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目的:贫血是维持性血液透析患者常见并发症之一,且血红蛋白难以维持稳定。本研究旨在探讨血红蛋白变异性与心脑血管事件及死亡的关联,为探索并制定更优化诊疗方案提供临床依据。方法:本研究对80例维持性血液透析患者随访9个月,每月检测血红蛋白水平,对血红蛋白及各变异性指标组间临床不良事件的发生情况进行比较分析。结果:临床心脑血管不良事件的独立危险因素为血红蛋白标准差、变异系数(%)、差值平均值;而血红蛋白平均值为其保护性因素。影响脑血管事件的独立危险因素为血红蛋白标准差和变异系数。影响心血管事件的独立危险因素为血红蛋白差值平均值。生存回归显示血红蛋白差值平均值为死亡的独立危险因素,血红蛋白平均值为保护性因素。结论:维持性血液透析患者普遍存在血红蛋白波动,其与心血管事件和死亡的相关性可能因判断血红蛋白变异性的标准不同而有差异。
Aims: Anemia is one of the common complications of maintenance hemodialysis patients, and hemoglobin is difficult to maintain stable. The purpose of this study is to explore the relationship between hemoglobin variability and cardiovascular and cerebrovascular events and death, and to provide a clinical basis for exploring and formulating a more optimal diagnosis and treatment plan. Methods: Eighty patients with maintenance hemodialysis were followed up for 9 months. The hemoglobin level was measured every month. The incidence of clinical adverse events between hemoglobin and each variability index group were compared and analyzed. Results: The independent risk factors of clinical cardiovascular and cerebrovascular adverse events were hemoglobin standard deviation, coefficient of variation (%) and mean difference, while the average value of hemoglobin was protective factor. Independent risk factors for cerebrovascular events were hemoglobin standard deviation and coefficient of variation. Independent risk factors affecting cardiovascular events were averages of hemoglobin differences. Survival regression showed that the mean hemoglobin difference was an independent risk factor for death and the mean hemoglobin was a protective factor. CONCLUSIONS: Hemoglobin fluctuations are common in patients undergoing maintenance hemodialysis and their association with cardiovascular events and death may differ depending on the criteria used to determine hemoglobin variability.