上海市透析患者贫血治疗现况调查  

A multicenter cross-sectional survey of anemia in patients with dialysis:a survey in Shanghai

作　　者：林攀[1] 刘中华[1] 邹建洲[1] 丁小强[1] 张金元[1] 汪年松[1] 何立群[1] 鲍晓荣[1] 徐树人[1] 严海东[1] 蒋更如[1] 张景红[1] 杨黄[1] 朱开元[1] 张薇[1] 

机构地区：[1]复旦大学上海医学院中山医院肾内科,上海200032

出　　处：《肾脏病与透析肾移植杂志》2011年第4期332-337,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：上海市科委重大课题"慢性肾病的规范化诊疗研究"(08dz1900602)

摘　　要：目的:了解维持性透析患者的贫血治疗情况及相关影响因素。方法:收集2008年8月～10月上海市12家综合医院1632例维持性血液透析(HD)和腹膜透析(PD)3月以上患者的临床和实验室检查资料。Hb达标指Hb≥110g/L,达标后暂时停止治疗也作为达标。结果:1632例患者中,1396例透析前Hb<110g/L的患者促红细胞生成素(EPO)治疗率为97.42%,HD组和PD组分别为98.32%和94.78%(P>0.05)。Hb达标率为62.38%,HD组患者显著高于PD组(70.53%vs40.86%,P<0.01)。1018例Hb达标患者平均Hb为(115.62±25.98)g/L,HD组显著高于PD组[(116.73±24.66)g/Lvs(111.95±20.69)g/L,P<0.05]。HD组和PD组EPO剂量分别为[(142.83±45.82)U/(kg·w)vs(155.30±33.78)U/(kg·w),P<0.05];铁剂治疗率为40.44%,HD组和PD组分别为44.10%和21.27%,口服铁剂治疗率分别为(33.43%vs18.66%,P<0.01),静脉铁剂治疗率分别为(11.24%和2.61%,P<0.01),静脉铁剂用量分别为[(98.94±12.11)mg/wvs(215.47±33.12)mg/w,P<0.01];HD组及PD组Hb达标患者EPO剂量均显著高于未达标患者分别为[176.88±21.27)U/(kg·w)vs(132.73±17.64)U/(kg·w),(182.19±25.36)U/(kg·w)vs(131.14±18.33)U/(kg·w),P<0.05],铁剂治疗率也显著高于未达标组(54.38%vs45.63%,P<0.01;43.24%vs7.7%,P<0.05)。结论:大部分透析患者均接受贫血治疗,但治疗仍不充分,Hb达标率较低,铁剂特别是静脉铁剂应用不足。HD组患者贫血治疗和Hb达标率优于PD组患者。EPO剂量不足和铁剂治疗率低是贫血治疗达标率低的主要原因。应重视肾性贫血的早期、充分治疗。Objective： To investigate the treatment of anemia in dialysis patients and the related factors. Methodology：A total of 1632 dialysis patients of 12 hospital in Shanghai during 2008.8 - 2008.10 were enrolled this study. Results：In 1396 patients whose Hb 〈 110 g/L, 97.4% patients had been treated with EPO, 95.5% and 94. 8% in HD and PD patients respectively （P 〈0.05）. There were 62.4% patients reached the Hb target（ 〉 110 g/L）, with 70. 5% in HD and 40. 9% in PD patients （ P 〈 0. 001 ）. The mean Hb was （ 116 ±25.9） g/L in the patients who reached the Hb target, with （ 117 ±24. 7 ） g/L in HD and（ 112 ±20. 7 ） g/L in PD patients （ P 〈 0. 05 ）. In HD and PD patients, the mean dose of EPO was （143±45.8） U/（kg.w） and （155 ±33.8） U/（kg-w） （P〈0. 05）. 40.4% patients were treated with iron, with 44. 1% in HD and 21.3% in PD patients, 33.4% and 18. 7% patients were treated with oral iron in HD and PD patients （P 〈 0.01 ）, 11.24% and 2. 61% patients were treated with intravenous iron in HD and PD patients （P 〈0. 01 ）, the mean dose of intravenous iron was （98.9±12. 1 ） mg/w and （215 ±33. 1 ）mg/w in HD and PD patients （ P 〈 0. 01 ）. The mean dose of EPO and iron treatment rate in the patients who reached the Hb goal was significantly higher than in the patients who didn＇t reached the Hb goal. Conclusion： Most of the anemic patients on dialysis had been treated with EPO, but there were also a great quantity of patients hadn＇t been treated with iron, especially with intravenous iron which results a low rate of reached Hb target. It is important to pay more attention in the treatment of anemia in dialysis patients.

关 键 词：贫血 透析 促红细胞生成素 铁剂 

分 类 号：R692.5[医药卫生—泌尿科学]