平均红细胞体积、红细胞分布宽度与血液透析患者透析中低血压的相关性分析

    Relationships between mean red blood cell volume,red blood cell distribution width and intradialytic hypotension in hemodialysis patients

      摘要
    • 摘要: 目的 分析平均红细胞体积（mean corpuscular volume，MCV）、红细胞分布宽度（redblood cell distribution width，RDW）与血液透析患者透析中低血压的相关性。方法 回顾性分析安徽省第二人民医院2020年8月至2021年9月收治的152例血液透析患者的临床资料，对比透析中低血压发生者与未发生者MCV、RDW水平，分析透析中发生低血压的影响因素，绘制受试者工作特征（receiver operating characteristic，ROC）曲线，分析MCV、RDW对血液透析患者透析中低血压发生的评估效能。结果 受试者透析中低血压发生率为23.68%（36/152）；透析中低血压发生者MCV明显低于未发生者（62.50±7.79比89.84±8.72，P<0.05），RDW明显高于未发生者（16.55±1.48比13.20±1.35，P<0.05）；透析中低血压发生者糖尿病肾病、透析龄>3年、MCV<82 fl、RDW>14.6%、营养不良、贫血、超滤速度过快、透析中进食、伴有冠心病、伴有房颤、透析前应用降压药、单室尿素清除指数（spKt/V）<0.8、深静脉置管、合并心力衰竭、合并心脏瓣膜病者构成比均高于未发生者（P<0.05），经Logistic回归分析证实均为透析中低血压发生的独立危险因素（P<0.05）；MCV与RDW单项评估血液透析患者透析中低血压发生的最佳截断点分别为79.78 fl、15.10%，二者联合的特异度、ROC曲线下面积均高于单独评估。结论 血液透析患者透析中低血压发生者的MCV低于未发生者，RDW普遍高于未发生者，MCV<82 fl、RDW>14.6%同糖尿病肾病等均是此类患者透析中低血压发生的独立危险因素，且MCV联合RDW对其具有良好的评估效能。

       

      Abstract: Objective To explore the relationships between mean corpuscular volume(MCV), red blood cell distribution width(RDW)and intradialytic hypotension in hemodialysis patients. Methods From August 2020 to September 2021,clinical data were retrospectively reviewed for 152 hemodialysis patients. The levels of MCV and RDW were compared between patients with intradialytic hypotension and those without intradialytic hypotension. The potential influencing factors of intradialytic hypotension were explored. Receiver operating characteristic(ROC)curves were plotted for examining the efficiencies of MCV and RDW in evaluating the occurrence of hypotension in hemodialysis patients. Results The incidence of intradialytic hypotension was 23. 68%(36/152)in patients with intradialytic hypotension. MCV of patients with intradialytic hypotension was significantly lower than those without intradialytic hypotension(62. 50±7. 79)vs(89. 84±8. 72),P<0. 05. And RDW of patients with intradialytic hypotension was significantly higher than those without intradialytic hypotension(16. 55±1. 48)vs (13. 20±1. 35),P<0. 05. The proportions of patients with diabetic nephropathy,dialysis vintage >3 years,MCV <82 fl,RDW >14. 6%,malnutrition,anemia,ultrafiltration rate,diet during dialysis, coronary heart disease,atrial fibrillation,antihypertensive agents pre-dialysis,single ventricular urea clearance index(spKt/V)<0. 8,deep venous catheterization,heart failure and valvular heart disease in patients with intradialytic hypotension were higher than those without intradialytic hypotension (P< 0. 05). Logistic regression analysis revealed that all of them were independent risk factors for intradialytic hypotension(P<0. 05). The optimal cut-off points of MCV and RDW in assessing the risk of intradialytic hypotension were 79. 78 fl and 15. 10% respectively. And specificity and area under ROC curve (AUC)of combining MCV and RDW were higher than those of single assessment. Conclusion MCV in patients with intradialytic hypotension is lower than those without intradialytic hypotension. And RDW in patients with intradialytic hypotension is higher than those without intradialytic hypotension. MCV < 82 fl,RDW >14. 6% and diabetic nephropathy are independent risk factors for intradialytic hypotension in patients on hemodialysis and MCV plus RDW offer an excellent evaluation tool.

       

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