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目的:了解维持性血液透析患者的红细胞体积分布宽度(red blood cell distribution width,RDW)及其影响因素。方法:分析2012年1月—3月复旦大学附属中山医院血液净化中心维持性透析患者356例,其中男性226例,女性130例;年龄(59.2±14.5)岁;透析龄(64.3±42.5)个月。收集所有患者的临床病史,并于周中透析前检测血红蛋白(Hb)、RDW、电解质、高敏C反应蛋白(hsCRP)、血清白蛋白、前白蛋白、铁蛋白、转铁蛋白饱和度、甲状旁腺素和N端脑钠肽前体(NT-proBNP),透析前后检测血肌酐、尿素氮并计算单室尿素清除指数(spKt/V)。结果:整组患者RDW为(15.14±1.22)%(13.0%～20.4%),中位数14.9%;241例(67.7%)患者RDW水平超过参考值上限。男性患者RDW水平低于女性患者[(15.03±1.11)%比(15.33±1.39)%,P<0.05]。Spearman相关分析提示,RDW与年龄(r=0.269,P<0.001)、透析龄(r=0.116,P=0.033)、每周促红细胞生成素(erythropoietin,EPO)剂量(r=0.250,P<0.001)、EPO/Hb比值(r=0.214,P<0.001)、hsCRP(r=0.335,P=<0.001)及NT-proBNP(r=0.133,P=0.027)呈正相关。RDW与血清白蛋白(r=-0.241,P<0.001)、前白蛋白(r=-0.334,P<0.001)呈负相关。多元线性逐步回归模型结果提示,RDW与血清白蛋白呈显著负相关(P<0.01)。结论:血液透析患者中RDW水平异常并不少见,且与年龄、透析龄、营养水平、炎性反应状态、心脏功能、EPO剂量及反应等多项临床指标有关。RDW对透析人群预后的预测作用有待于进一步研究证实。
Objective: To investigate the red blood cell distribution width (RDW) and its influencing factors in maintenance hemodialysis patients. Methods: A total of 356 patients with maintenance dialysis in Zhongshan Hospital of Fudan University from January to March 2012 were analyzed retrospectively, including 226 males and 130 females, aged 59.2 ± 14.5 years and 64.3 ± 42.5 years month. The clinical history of all patients was collected and hemoglobin (Hb), RDW, electrolytes, hsCRP, serum albumin, prealbumin, ferritin, transferrin saturation, parathyroid N-terminal pro-brain natriuretic peptide (NT-proBNP), serum creatinine and urea nitrogen were measured before and after dialysis, and single compartment urea clearance index (spKt / V) was calculated. Results: The RDW in the whole group was (15.14 ± 1.22)% (13.0% ~ 20.4%) with a median of 14.9%. The RDW level in 241 patients (67.7%) exceeded the upper limit of the reference value. The level of RDW in male patients was lower than that in female patients [(15.03 ± 1.11)% vs (15.33 ± 1.39)%, P <0.05]. Spearman correlation analysis showed that RDW was positively correlated with age (r = 0.269, P <0.001), dialysis age (r = 0.116, P = 0.033), weekly erythropoietin (EPO) dose , EPO / Hb ratio (r = 0.214, P <0.001), hsCRP (r = 0.335, P = 0.001) and NT-proBNP (r = 0.133, P = 0.027) RDW was negatively correlated with serum albumin (r = -0.241, P <0.001) and prealbumin (r = -0.334, P <0.001). The results of multivariate linear stepwise regression model showed that there was a significant negative correlation between RDW and serum albumin (P <0.01). Conclusion: The abnormal RDW level in hemodialysis patients is not uncommon, and it is related to many clinical indexes such as age, dialysis age, nutrition level, inflammatory reaction status, cardiac function, EPO dose and response. The predictive value of RDW on the prognosis of dialysis patients remains to be confirmed by further studies.