【摘要】目的探讨白蛋白与C 反应蛋白比值(albumin/C-reactive protein，Alb/CRP)、红细胞分布宽度(red blood cell distribution width，RDW)、血尿酸(serum uric acid，SUA)与终末期肾病(end stage renal disease，ESRD)维持性血液透析(maintenance hemodialysis，MHD)患者预后的关系，并分析各指标联合预测预后的价值。方法选取空军军医大学第一附属医院265 例ESRD 患者，均行MHD 治疗，6 个月后根据患者生存状况分为死亡组(n=31)、存活组(n=234)，比较2 组临床资料、Alb/CRP、RDW、SUA水平，分析各指标及联合预测预后的价值。结果265 例ESRD 患者MHD 治疗6 个月共有31 例死亡，死亡率11.70%；与治疗前相比，2 组治疗3 个月、5 个月后Alb/CRP、SUA 均降低，RDW 均升高，且死亡组Alb/CRP、SUA 低于存活组(F=18.261、20.608，P 均＜0.001)，RDW 高于存活组(F=16.256, P＜0.001)；治疗3 个月、5 个月后Alb/CRP(OR=0.507, 95%CI：0.315～0.817；OR=0.610, 95% CI：0.405～0.918)、SUA(OR=0.391，95%CI：1.264～1.417；OR=0.445，95%CI：0.205～0.964)、RDW(OR=1.338，95%CI：1.264～1.417；OR=1.439，95%CI：1.355～1.529)水平变化均为ESRD 患者MHD 治疗预后的影响因素(P 均＜0.001)；治疗3 个月、5 个
月后Alb/CRP、RDW、SUA 预测ESRD 患者MHD 治疗预后的AUC 均＞0.7，其中治疗5 个月后各指标联合预测预后的AUC 最大，为0.890。结论Alb/CRP、RDW、SUA 与ESRD 患者MHD 治疗的预后相关，各指标联合在预测患者预后方面具有较高价值。
【Abstract】Objective To predict prognosis of the end stage renal disease (ESRD) patients with maintenance hemodialysis (MHD) by using albumin/C-reactive protein ratio (ALB/CRP), red blood cell distribution width (RDW), serum uric acid (SUA) and integration of the three indicators. Methods A total of 265 ESRD patients treated with MHD in the First Affiliated Hospital of Air Force Medical University were enrolled in this study. After 6 months of MHD, they were divided into death group (n=31) and survival group (n=234) according to their survival status. Clinical data, and ALB/CRP, RDW and SUA levels were compared between the two groups. Logistic regression was conducted to analyze the prognostic factors. Receiver operating characteristic curve (ROC) was used to estimate the prognostic values of the three indicators and the integrated value of the three indicators. Results Among the 265 ESRD patients, 31 died in the 6 months of MHD, with a mortality rate of 11.70%. After 3 months and 5 months of MHD, ALB/CRP and SUA were significantly decreased, and RDW was significantly increased in both groups; ALB/CRP and SUA were lower (F=18.261, 20.608, P＜0.001) and RDW was higher (F=16.256, P＜0.001) in the death group than in the survival group; the changes of ALB/CRP (OR=0.507, 95% CI: 0.315～0.817; OR=0.610, 95% CI: 0.405～0.918), SUA (OR= 0.391, 95% CI: 1.264～1.417; OR=0.445, 95% CI: 0.205～0.964) and RDW (OR=1.338, 95% CI: 1.264～ 1.417; OR=1.439, 95% CI: 1.355～1.529) were the influencing factors for prognosis of the ESRD patients with MHD (P＜0.001); After 3 and 5 months of MHD, the area under the curve (AUC) of ALB/CRP, RDW and SUA levels to predict prognosis of the ESRD patients with MHD was＞0.7; after 5 months of MHD, the AUC of the integrated value of the three indicators to predict prognosis became bigger (0.890). Conclusion ALB/CRP, RDW and SUA are significantly correlated with the prognosis of ESRD patients with MHD. The integration of the 3 indicators has a higher value to predict prognosis of these patients.
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