维持性血液透析患者贫血及相关因素分析  

Related factors of anemia in maintenance hemodialysis patients

作　　者：侯新艳[1] 刘帝[2] 刘烨歆 谭夏[2] 李慧琼[2] 刘海洋[2] 袁芳[2] 贺理宇[2] 刘煜[2] 王畅[2] 周乐天[2] 张磊[2] 李铮[2] 陈国纯[2] 陈晓君[2] 刘虹[2] 

机构地区：[1]湖南省湘潭市第一人民医院肾内科,湘潭411100 [2]中南大学湘雅二医院肾内科,长沙410011

出　　处：《临床肾脏病杂志》2016年第12期718-722,共5页Journal Of Clinical Nephrology

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血红蛋白(hemoglobin,Hb)达标情况及其相关影响因素。方法选择2014年1月1日至2015年1月1日间在我院血液透析中心规律行血液透析3个月以上的终末期肾脏疾病患者作为研究对象,收集患者的基本资料(年龄、性别、原发病、体质量、透析时间、透析频率、药物使用情况等)和实验室指标(Hb、铁蛋白、血白蛋白、尿素氮、血肌酐等)以及促红细胞生成素(erythropoietin,EPO)及铁剂使用情况;统计本中心患者Hb达标情况,再根据Hb水平进行分组,采用χ~2检验比较各组间Hb达标情况及EPO、铁剂的使用情况,并对EPO剂量采用Pearson线性相关分析,铁剂的使用采用秩相关分析。结果①本次研究共纳入的257例MHD患者中,按Hb≥110 g/L为达标Hb进行统计,达标患者123例(占46.70%),未达标患者134例(占53.3%)。Hb达标率与国内研究相比基本相似,较国际发达国家水平低。将患者按原发病发病率分组,发病率前五位的分别为高血压肾病92例(占35.80%),慢性肾小球肾炎82例(占31.91%),糖尿病肾脏疾病40例(占15.56%),多囊肾病7例(占2.72%),痛风6例(占2.33%);不同原发病之间贫血患病率的差异具有统计学意义(P<0.05)。②将患者按Hb值分组,未达标组的EPO使用量较达标组的EPO使用量低[(60.54±50.41)IU·Kg^(-1)·W^(-1)比(136.51±36.32)IU·Kg^(-1)·W^(-1),P<0.001],未达标组静脉铁剂使用量比达标组低[(139.01±52.08)mg比(150.00±78.59)mg,P<0.001],2组的年龄、体质量、透析时间、铁蛋白、血白蛋白、尿素氮、血肌酐的差异均无统计学意义(P>0.05)。根据患者使用铁剂的情况分组,静脉铁剂组和口服铁剂组间Hb水平的差异均无统计学意义(P>0.05)。③通过相关分析显示,Hb与EPO剂量呈正相关(r=0.849,P<0.01),而与铁剂的使用呈正相关(r=0.196,P<0.01)。结论①本血液透析中心MHD患者的贫血治疗达标率为46.7%,与国内研�Objective To investigate the target achievements of hemoglobin in maintenance he- modialysis （MHD） patients and related influencing factors in our center. Methods The study focused on the patients with end stage renal disease who had done hemodialysis more than 3 months in our hospital. We collected the information of age, sex, primary disease, weight, hemodialysis duration, hemodialysis frequency, appendix medicines and the examination records of ferritin, albumin, blood u-rine nitrogen, serum creatinine from January 1, 2014 to January 1, 2015. Then we classified the patients into different groups according to hemoglobin （Hb） level, with the chi-square test to compare the Hb levels, usage condition of erythropoietin and ferralia among these groups. Results （1） 257 MHD patients were involved in this research with the level of Hb ≥110 g/L as the target value. 123 patients reached the target level, accounting for 46. 7%, and 134 patients did not reach the target lev- el, accounting for 53.3%. The target rate of Hb level was similar with domestic, but lower than foreign developed countries. These patients were assigned to different groups on the basis of their primary disease, and the top 5 were as follows： hypertensive kidney diseases（92 cases, 35.80%）, chronic nephropathy（82 cases, 31.91% ）, diabetic kidney diseases （40, 15.56% ）, polycystic kidney （7, 2. 72%）, gout （6, 2. 33%）. The prevalence of anemia among these primary diseases showed significant difference（P = 0. 042〈0. 05）. （2） The patients were classified by Hb levels. The dose of EPO [（60. 54±50.4） IU.kg-1 .W-1 vs. （136. 51 ± 36. 32） IU.kg-1.W-1 , P〈0. 001] and intravenous iron [（139. 01 ± 52. 08） mg vs. （150 ± 78. 59） mg, P〈0. 001） in Hb〈110 g/L group were lower than in Hb ≥110 group. However, there were no statistically significant differences in age, weight, hemodialysis duration, ferritin, albumin, serum uric acid, serum creatinine between Hb〈110 g/L group and Hb ≥110 grou

关 键 词：血液透析 维持性 肾性贫血 铁剂 血红蛋白 

分 类 号：R692.5[医药卫生—泌尿科学] R556[医药卫生—外科学]