机构地区:[1]安徽医科大学第二附属医院肾内科,合肥230601 [2]马鞍山市中心医院肾内科,安徽省马鞍山市243099 [3]马鞍山市人民医院肾内科,安徽省马鞍山市243099 [4]蚌埠医学院第一附属医院肾内科,安徽省蚌埠市233004 [5]安庆市石化医院血液净化中心,安徽省安庆市246002 [6]安庆市立医院肾内科,安徽省安庆市246003 [7]解放军八六医院肾内科,安徽省马鞍山市243199 [8]淮南市第一人民医院肾内科,安徽省淮南市232007 [9]黄山市人民医院血液净化科,安徽省黄山市245099 [10]广德县人民医院肾内科,安徽省广德县242299 [11]阜阳市第二人民医院血液净化中心,安徽省阜阳市236011 [12]合肥市第五人民医院肾内科,合肥230001 [13]宣城市人民医院肾内科,安徽省宣城市242099 [14]六安市人民医院肾内科,安徽省六安市237005 [15]皖北煤电集团总医院肾内科,安徽省宿州市234099 [16]合肥市第一人民医院肾内科,合肥230001 [17]六安市第四人民医院肾内科,安徽省六安市237009 [18]中铁四局集团第二医院血透室,安徽省阜阳市236054 [19]宁国市人民医院肾内科,安徽省宁国市242399 [20]池州市人民医院肾内科,安徽省池州市247099 [21]合肥市第二人民医院肾内科,合肥230011 [22]滁州市第一人民医院肾内科,安徽省滁州市239004 [23]淮北市人民医院肾内科,安徽省淮北市235099 [24]滁州市第二人民医院肾内科,安徽省滁州市239004 [25]濉溪县医院肾内科,安徽省淮北市235199 [26]合肥市滨湖医院肾内科,合肥230601
出 处:《中华肾脏病杂志》2016年第4期264-270,共7页Chinese Journal of Nephrology
基 金:安徽省卫生厅临床技术项目(09C152);安徽省高校省级自然科学研究项目(KJ20132155);安徽医科大学科研基金(2015xkj110)
摘 要:目的调查安徽省维持性血液透析(MHD)患者贫血患病率、血红蛋白达标率及影响血红蛋白达标因素。方法纳入2014年1月1日至2014年03月31日期间在安徽省皖南、皖中、皖北13市26家医院行MHD的成年患者2601例。收集患者年龄、性别、原发病、透析龄、透析方式、药物使用及实验室检查等资料,以浓度≥110g/L为血红蛋白达标标准,分析贫血患病率、血红蛋白达标率及影响血红蛋白达标因素。结果(1)安徽省MHD患者血红蛋白平均浓度为(100.2±28.1)gm,贫血患病率为82.5%,红细胞生成素使用率为95.2%,铁剂使用率为64.3%,叶酸使用率为62.0%。(2)MHD患者血红蛋白达标率为32.8%,男性患者中血红蛋白达标率高于女性(35.1%比29.4%,P=0.002),高通量透析患者血红蛋白达标率高于低通量透析患者(39.2%比27.9%,P〈0.001)。(3)与血红蛋白达标患者比较,血红蛋白未达标患者女性比例高,透析龄短,血清白蛋白、肌酐、三酰甘油、钙、磷、镁水平低,而血清超敏c反应蛋白明显增加,红细胞生成素、铁剂和叶酸使用率均增加(均P〈0.05)。(4)多因素Logistic回归分析发现,2.10—2.50mmol/L钙(OR=O.346,P=0.005)、〉2.50mmol/L钙(OR=0.207,P=0.001)、〉41.9g/L白蛋白(OR=0.511,P=0.044)、1.11~2.01mmol/L三酰甘油(OR=0.443,P=0.008)、〉2.0lmmol/L三酰甘油(OR=0.257,P〈0.001)及≥7.63mg/L超敏C反应蛋白(OR=1.652,P=0.049)可能是血红蛋白未达标的影响因素。结论安徽省MHD患者贫血患病率高,血红蛋白达标率低;达标钙、高钙、高白蛋白及三酰甘油可能为影响血红蛋白达标的保护因素,而高超敏C反应蛋白可能为其独立危险因素。因此,充分透析、改善营养状态、纠正钙磷代谢紊乱和微炎性反应等,可能提Objective To explore the prevalence of anemia, percentage of patients with hemoglobin (Hb) reaching the guideline target, and its impact factors in maintenance hemodialysis (MHD) patients in Anhui province. Methods Two thousand six hundred and one cases of MHD patients were investigated in hemodialysis centers of 26 hospitals in southern, northern and central Anhui province from January 1st, 2014 to March 31st, 2014. Age, gender and clinical information on renal disease history, duration of dialysis therapy, types of dialysis, medical history, and laboratory results, were collected. The prevalence of anemia, percentage of patients with Hb levels reaching the guideline target (Hb≥110 g/L) and the associated factors of Hb were analyzed. Results (1) Mean Hb concentration was (100.2:t28.1) g/L, 82.5% of patients were diagnosed as anemia. The use rate of erythropoietin, intravenous iron and folic acid were 95.2%, 64.3% and 62.0% respectively. (2) Hb≥ 110 g/L rate was 32.8%. The percentage of patients with Hb≥110 g/L was higher in males than that in females (35.1% vs 29.4%, P=0.002). Patients with high flux dialysis had a higher percentage of Hb≥ 110 g/L than those with low flux dialysis (39.2% vs 27.9%, P 〈 0.001). (3) Compared with patients whose Hh≥110 g/L, patients with 〈 110 g/L had shorter duration of dialysis therapy, lower albumin, creatinine, triglyceride, calcium, phosphorus, magnesium, and higher hs- CRP, higher usage rates of erythropoietin, intravenous iron and folic acid (all P 〈 0.05). (4) The 2.10-2.50 mmol/L calcium (OR= 0.346, P=0.005), 〉 2.50 mmol/L calcium (OR=0.207, P=0.001), 〉 41.9 g/L albumin (OR=0.511, P= 0.044), 1.11- 2.01 mmol/L triglyceride (OR=0.443, P=0.008), 〉 2.01 mmol/L triglyceride (0R=0.257, P 〈 0.001) and ≥7.63 mg/L hs-CRP (OR=1.652, P=0.049) were influence factors causing Hb to fall below. Conclusions There are high prevalence of anemia and low control rate of hemoglobin in MHD patients in
分 类 号:R556[医药卫生—血液循环系统疾病] R459.5[医药卫生—内科学]
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