DOPPS研究引发的思考_血红蛋白波动与透析患者死亡正相关.pdfVIP

·210· 中国血液净化2012年4月第11卷第4期 Chin J Blood Purif, April, 20 12, Vol.11, No.4 ·指南解读 · DOPPS研究引发的思考-血红蛋白波动与透析患者死亡正相关 陈 雅 倪兆慧 【摘要】随着对肾性贫血管理的深入，不少文献报导 “血红蛋白稳定对于肾性贫血治疗的重要性 及临床获益”，多个国外研究及数据显示血红蛋白不稳定与透析(与非透析)患者死亡率直接相关，同 时可增加透析患者的并发症及住院风险等。其中，最引人注目的是DOPPS研究。本文从DOPPS研究结 果出发，探讨透析患者，尤其是血液透析患者中血红蛋白波动情况及其影响因素，血红蛋白波动与透 析患者生存、转归情况的关系，血红蛋白的目标制定及对今后临床实践的指导意义。 【关键词】血红蛋白；DOPPS研究；透析 中图分类号：R318.16文献标识码： Considerations from the DOPPS study-hemoglobin fluctuation is positively correlated to mortality in dialysis patients CHEN Ya, NI Zhao-hui. D ep artment of N ep hrology, R enj i H osp ital, Shang hai J iaotong University, Shanghai 20012 7, China Corresp onding author: NI Zhao-hui, Email:p rof nizhao@12 6.com 【Abstract 】With the progresses of renal anemia administration, many researches recognize that hemoglobin stability is an important index for the treatment and prognosis of renal anemia. Evidences from other countries indicate that hemoglobin in stability has a direct relation ship with mortality in dialysis and non-dialysis patients. Among these studies, the DOPP S study is worthwhile to be concerned. Here we discu ss hemoglobin fluctuation and its related factors, the relation ship between hemoglobin fluctuation and patient ’s survival and outcome, the ideal target of hemoglobin level, and its clinical significance in dialysis patients especially in hemodialysis patients. 【Key words 】Hemoglobin fluctuation ; DOPP S study; Dialysis 1 DOPPS简介及主要结果 经过挑选，分别有6167，5517及7104名患者分别 进入上述3个模型进行分析。在3月滞后模型中， DOPPS(Dialysis Outcomes and Practice Pat- terns Study)研究旨在评估HD患者的实践及预后(包 发生终末期肾脏病 ， ESRD)与最早记录Hb值的时间间隔中位数为1.3年， 括并发症、病死率及生活质量)以期提高HD(Hem- [1] 存在风险的总时