维持性腹膜透析患者血红蛋白影响因素分析  

The analysis of influencing factors of hemoglobin in peritoneal dialysis patients

作　　者：张锁建[1] 曹娟[1] 李海涛[1] 周长菊[1] 章旭[1] ZHANG Suo-jian;CAO Juan;LI Hai-tao;ZHOU Chang-ju;ZHANG Xu(Department of Nephrology, Taixing People's Hospital,Jiangsu 225400 Taixing, China)

机构地区：[1]江苏省泰兴市人民医院肾内科/泰州市肾脏病临床研究中心

出　　处：《临床肾脏病杂志》2019年第6期430-433,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨维持性腹膜透析(PD)患者血红蛋白(Hb)水平的影响因素。方法 采用横断面调查研究,调查在2018年1月至2018年6月期间泰兴市人民医院肾内科腹透中心规律随访的126例维持性PD患者的Hb情况,同时收集PD患者人口学资料及相关生化指标;按照是否贫血(Hb<110g/L视为贫血)分为两组,比较两组相关资料,探索Hb的影响因素。结果 126例PD患者平均Hb水平为(108.1±18.6)g/L,贫血62例,Hb正常64例,贫血发生率49.2%;与贫血组相比,Hb正常组男性比例较高,24h尿量较多,残余肾功能(residual renal function,RRF)较好,重组人促红细胞生成素(erythropoietin,EPO)使用剂量较少,铁蛋白及转铁蛋白饱和度较高(P<0.05),但两组患者的年龄、身高、体质量、体质量指数(BMI)、糖尿病比例、血压、白蛋白、前白蛋白、血脂、C反应蛋白、叶酸、维生素B12、甲状旁腺素(parathyroid hormone,PTH)水平、尿素清除指数(Kt/V)无统计学差异。Hb与RRF(r=0.310,P=0.001)、尿量(r=0.312,P=0.001)、白蛋白(r=0.223,P=0.012)、铁蛋白(r=0.288,P=0.001)、转铁蛋白饱和度(r=0.327,P=0.001)呈正相关,与EPO使用剂量(r=-0.707,P=0.001)呈负相关,与身高、体质量、BMI、Kt/V、血压、前白蛋白、血脂、C反应蛋白、叶酸、维生素B12、PTH无相关性。采用逐步线性回归发现,性别、RRF、转铁蛋白饱和度是Hb的独立影响因素。结论 PD患者贫血发生率较高,女性、RRF较差、铁缺乏是PD患者发生贫血的危险因素。Objective To investigate the influencing factors of hemoglobin (Hb) in peritoneal dialysis (PD) patients. Methods A cross-sectional study was performed to investigate the Hb data of 126 PD patients in Peritoneal Dialysis Center of Taixing People's Hospital from January 2018 to June 2018. Demographic data and related biochemical indexes of the PD patients were collected at the same time. All the patients were divided into two groups according to their Hb levels (Hb<110 g/L was considered as anemia) and relevant data were compared between the two groups to explore the influencing factors of Hb. Results The mean Hb level was (108.1±18.6) g/L. Anemia was present in 62 patients and normal Hb in 64 patients with an anemia rate of 49.2%. When compared with the anemic group, the normal Hb group had a higher proportion of male patients, more urine volume, better residual renal function (RRF), less dose of recombinant human erythropoietin (EPO), and higher level of ferritin and transferrin saturation ( P < 0.05 ). There was no statistical difference in age, height, weight, body mass index (BMI), diabetes proportion, albumin, prealbumin, blood lipid, c-reactive protein, folic acid, vitamin B 12 , parathyroid hormone (PTH) level and urea clearance index (Kt/V) between the two groups. Hb levels was correlated positively with RRF ( r =0.310, P =0.001), urine volume ( r =0.312, P =0.001), albumin ( r =0.223, P =0.012), ferritin ( r =0.288, P =0.001) and transferrin saturation ( r =0.327, P =0.001), and negatively with EPO dose/ weight ( r =0.707, P =0.001). There was no association of Hb with height, weight, BMI, blood pressure, Kt/V, albumin, blood lipid, CRP, folic acid, vitamin B 12 , PTH. Multivariate stepwise linear regression showed that gender, RRF and transferrin saturation were independent influencing factors of hemoglobin. Conclusions The incidence of anemia is high in patients with peritoneal dialysis. Female, poor RRF and iron deficiency were risk factors associated with the occurrence of anemia in this population.

关 键 词：腹膜透析 血红蛋白 性别 残余肾功能 铁缺乏 

分 类 号：R692.5[医药卫生—泌尿科学]