【摘要】目的慢性肾脏病(chronic kidney disease,CKD)和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)对血红蛋白的影响作用相反。本研究分析同时合并这两种疾病时血红蛋白的水平以及异常血红蛋白对住院患者不良预后的影响。方法将12 所医院的96 930 例COPD 患者的电子数据进行回顾性研究。用血肌酐值估算肾小球滤过率判断CKD。取住院期间血红蛋白均值进行研究。结果住院COPD 人群中12.7%合并CKD，贫血和红细胞增多症的比例分别为39.5%和2.9%。随着CKD 进展，贫血的比例逐渐增加，红细胞增多症比例减少。CKD 和两种类型的红细胞异常均与住院死亡相关。经老年和Charlson 合并症评分校正后，无CKD 患者的贫血增加了住院死亡风险，优势比分别为1.460(95% CI 1.278～1.667,P＜0.001)，但CKD 患者的贫血与死亡无关。在无CKD、早期和进展期CKD患者中，红细胞增多症均与死亡独立相关，优势比分别为2.191(95% CI 1.654～2.902,P＜0.001)、2.034(95% CI 1.169～3.541,P=0.012)和3.687(95% CI 1.432～9.490,P＜0.007)。结论CKD 加重了住院COPD 患者贫血。贫血是非CKD 患者院内死亡的危险因素；而对于所有COPD 患者，红细胞增多症都与死亡相关。
王晓虹, 陈源汉, 苏杨, 何强, 陈诗歆, 王文姬, 刘国辉, 廖元江, 陆晨, 孙晶, 张裕生, 梁馨苓
. 慢性肾脏病和血红蛋白异常对住院慢性阻塞性肺疾病不良预后的影响[J]. 中国血液净化, 2019
, 18(03)
: 166
-169
.
DOI: 10.3969/j.issn.1671-4091.2019.02.006
【Abstract】Purpose The roles of chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) on hemoglobin level are mutually contradicted. The aim of this study was to analyze the hemoglobin level in hospitalized patients with the both conditions and the detrimental effect of abnormal hemoglobin levels. Methods Clinical data were recruited from electronic medical records in the 12 hospitals. CKD was diagnosed by the creatinine estimated glomerular filtration rate. The mean hemoglobin level during hospitalization was used for the investigation. Results CKD occurred in 12.7% of hospitalized COPD patients. The incidences of anemia and polycythemia were 39.5% and 2.9%, respectively. With the progression of CKD, the incidence of anemia increased, while the incidence of polycythemia decreased. Univariate regression showed that CKD and both types of abnormal hemoglobin levels were associated with in-hospital mortality. After adjusted by elderly and the Charlson comorbidity score, anemia increased the risk of in- hospital mortality in patients without CKD (odds ratio 1.460, 95% CI 1.278～1.667,P＜0.001). However, anemia was not related to the mortality in CKD patients. Polycythemia was associated with the mortality in patients without CKD, early CKD and advanced CKD (odds ratios were 2.191, 2.034 and 3.687, respectively; 95% CIs were 1.654～2.902, 1.169～3.541,P=0.012 and 1.432～9.490,P＜0.007, respectively). Conclusion CKD aggravated anemia in hospitalized COPD patients. Anemia was a risk factor for in-hospital mortality in patients without CKD. Polycythemia was associated with the mortality in all COPD patients.
