目的 探讨红细胞分布宽度与白蛋白比值(red blood cell distribution width-to-albumin ratio，RAR)与维持性血液透析(maintenance hemodialysis，MHD)患者全因死亡的相关性。 方法 选取南京市中心医院血液净化中心2014年11月─2020年11月收治的血液透析患者为研究对象，随访至研究终点死亡24例、生存76例，收集基线临床资料及实验室检查指标，比较死亡组和生存组的差异，分析RAR与MHD患者全因死亡的相关性。 结果 死亡组患者年龄大于生存组患者(Z=-4.086，P＜0.001)；死亡组患者合并糖尿病比例、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio，NLR)、单核细胞与淋巴细胞比值(monocyte-to-lymphocyte ratio，MLR)、RAR、C反应蛋白(CRP)高于生存组患者(χ²/Z =5.099、-2.215、-2.163、-2.797、-2.680，P=0.024、0.027、0.031、0.005、0.007)；死亡组患者HDL-C低于生存组患者(Z=-2.741，P=0.006)。多因素COX回归分析显示：年龄(HR=1.073，95% CI:1.030～1.118，P=0.001)、合并糖尿病(HR=8.197，95% CI:2.911～23.082，P＜0.001)、RAR(HR=33.179，95% CI:1.588～693.181，P=0.024)和CRP(HR=1.178，95% CI:1.059～1.310，P =0.002)是MHD患者全因死亡的独立危险因素。高RAR组总体生存率低于低RAR组(χ2=20.341，P＜0.001)。RAR、CRP以及两者联合预测MHD患者全因死亡的ROC曲线下面积分别为0.690(95% CI:0.582～0.798，P=0.005)、0.682(95% CI:0.560～0.804，P=0.007)、0.738(95% CI:0.633～0.843，P＜0.001)。 结论 RAR与MHD患者全因死亡具有相关性，RAR与CRP联合对MHD患者全因死亡具有更好的预测价值。

Objective  To explore the correlation between red blood cell distribution width to albumin ratio (RAR) and all-cause mortality in maintenance hemodialysis (MHD) patients.  Methods  A total of 100 MHD patients who met the inclusion criteria were recruited, and 24 patients died and 76 survived at the study endpoint. Their baseline clinical data and laboratory indicators were collected and compared between the death group and the survival group.  The correlation between RAR and all-cause mortality in the MHD patients was analyzed.  Results  Patients in the death group were older than those in the survival group (Z=        -4.086, P＜0.001). The proportion of patients with diabetes, neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), RAR and C-reactive protein (CRP) were higher in the death group than in the survival group (χ²/Z=5.099, -2.215, -2.163, -2.797 and -2.680 respectively; P=0.024, 0.027, 0.031, 0.005 and 0.007 respectively). Serum HDL-C was lower in the death group than in the survival group (Z=-2.741, P=0.006). Multivariate Cox regression analysis suggested that age (HR=1.073, 95% CI:1.030～1.118, P=0.001), diabetes (HR=8.197, 95% CI:2.911～23.082, P＜0.001), RAR (HR=33.179, 95% CI:1.588～693.181, P=0.024) and CRP (HR=1.178, 95% CI:1.059～1.310, P=0.002) were the risk factors for all-cause mortality. The overall survival rate was lower in the patients with higher RAR than in those with lower RAR (χ2=20.341, P＜0.001). ROC curves using RAR, CRP and combination of RAR and CRP to predict all-cause mortality in MHD patients showed that the area under curves were 0.690 (95% CI:0.582～0.798, P=0.005), 0.682 (95% CI:0.560～0.804, P=0.007) and 0.738 (95% CI:0.633～0.843, P＜0.001) respectively.   Conclusion  RAR is correlated with all-cause mortality in MHD patients. The combination of RAR and CRP will have better predictive value for all-cause mortality in MHD patients.