维持性血液透析患者血红蛋白变异性影响因素分析  

Factors related to Hb-Var in maintenance hemodialysis patients

作　　者：肖晓芬[1] 黄海明[1] 王小琴[2] 

机构地区：[1]湖北中医药大学2013级硕士研究生,武汉430061 [2]湖北省中医院肾内科

出　　处：《临床肾脏病杂志》2015年第6期338-342,共5页Journal Of Clinical Nephrology

基　　金：武汉市科技局软科学项目(No.201141333440-1)

摘　　要：目的调查分析湖北省中医院维持性血液透析（maintenancehemodialysis，MHD）患者血红蛋白变异性（hemoglobinvariability，Hb-Var）情况，并探讨Hb-Var的影响因素。方法选取湖北省中医院血液净化中心2013年12月至2014年6月期间MHD患者56例，入组时收集患者基本资料，随访6个月内记录患者使用红细胞生成刺激剂（erythropoietinstimulatingagents，ESAs）剂量、ESAs调整次数、静脉铁剂总量、血液透析滤过及血液灌流次数，6个月内至少检查3次实验室指标，包括血红蛋白（hemoglobin，Hb）、血钙（calcium，Ca）、血磷（phosphorus，P）、全段甲状旁腺素（immuno—reactiveparathyroidhormone，iPTH）、血清铁蛋白（serumferritin，SF）、血清白蛋白（albumin，Alb）。以血红蛋白变异系数（hemoglobin-coefficientofvariation，Hb_CV）代表Hb-Var，分析HtrVar的影响因素。结果①血红蛋白波动组43例，占总例数76．79％；②单因素分析发现，在性别、年龄、透析龄、血管通路、静脉铁剂总量、ESAs调整次数方面，Hb-CV差异有统计学意义（P〈0．05）；③Pearson相关分析显示，HlyCV与ESAS调整次数、静脉铁剂总量呈正相关（r值分别为0．757、0．264，P〈0．05），与透析龄、SF、Alb呈负相关（r值分别为-0．323，-0．390，-0．418，P％0．05），与年龄、血钙、血磷、iPTH无相关性；④Hb-CV影响因素的多元线性回归分析，性别、血管通路、ESAs调整次数、静脉铁剂总量、SF与Hb-CV独立相关。结论MHD患者普遍存在Hb-Var，年龄越大血红蛋白波动可能更明显。血红蛋白的波动与性别、血管通路、使用静脉铁剂关系密切。Hb-Var与慢性肾脏病预后的关系尚存争议，需进一步研究证实。Objective To investigation and analysis the hemoglobin variability（Hb-Var） of ma- intenance hemodialysis（MHD） patients in the Hubei Provincial Hospital of Traditional Chinese Medi- cine and explore the factors related to Hb-Var. Methods The study enrolled 56 MHD patients in the Blood Purification Center, Hubei Provincial Hospital of Traditional Chinese Medicine between Decem- ber 2013 and June 2014. Demographics and characteristics at baseline were collected. The doses of erythropoietin stimulating agents（ESAs） and intravenous doses of iron, and the number of adjusting ESAs, hemodiafiltration（HDF） and hemoperfusion（HP） were recorded during a follow-up period of 6 months. The laboratory parameters including hemoglobin （Hb）, calcium（Ca）, phosphorus（P）, im- munoreactive parathyroid hormone（iPTH）, serum ferritin（SF）, and albumin（Alb） were determined at least three times during the follow-up period of 6 months. The Hb-Var was described by Hb coeffi- cient of variation（Hb-CV） and fluctuation across threshold of the Hb level. The factors related to Hb- Var were analyzed. Results （1）There were 43 patients in the groups of Hb amplitude, accounting for 76. 79%; （2）Hb-CV was significantly different in gender, age, age of hemodialysis, vascular access for hemodialysis, dose of intravenous iron, and the number of adjusting ESAs（P〈0. 05） ; （3）Pearsoncorrelation analysis revealed that Hb-CV was positively correlated with dose of the number of adjusting ESAs（r= 0. 757, P〈0. 05） and dose of intravenous iron（r = 0. 757, P〈0. 05）, but negatively with age of hemodialysis（r=- 0. 323, P〈0. 05）, serum ferritin（r =- 0. 390, P〈0. 05） and albumin（r = -0. 418, P〈0. 05）, but not with age, calcium, phosphorus and immunoreactive parathyroid hor- mone; （4）Multiple regression analysis revealed that gender, vascular access for hemodialysis, the number of adjusting ESAs, dose of intravenous iron, and SF were independently associated with Hb- CV. Co

关 键 词：维持性血液透析 血红蛋白 变异 

分 类 号：R459.5[医药卫生—治疗学]