单中心腹膜透析患者血红蛋白达标率及相关因素分析  

Hemoglobin level and its related factors in patients undergoing peritoneal dialysis

作　　者：刘朝霞[1] 曹红霞[1] 徐兴欣[1] 卢文[1] 戴宏[1] Liu Zhao-xia;Cao Hong-xia;Xu Xing-xin;Lu Wen;Dai Hong(Department of Nephrology,First Affiliated Hospital,Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院肾脏内科,合肥230022

出　　处：《临床肾脏病杂志》2021年第7期562-567,共6页Journal Of Clinical Nephrology

基　　金：安徽省自然科学基金青年项目(1708085QH178)

摘　　要：目的通过调查腹膜透析(peritoneal dialysis,PD)患者贫血状况,分析影响血红蛋白(hemoglobin,Hb)达标的因素。方法收集2019年5月1日至9月30日间在安徽医科大学第一附属医院腹膜透析中心规律随访的所有年龄≥18岁且透析龄≥3个月的随访资料完整的PD患者280例,以Hb≥110 g/L为血红蛋白达标标准,分析Hb达标率及影响Hb达标因素。结果(1)PD患者Hb浓度为(106.08±20.42)g/L,Hb达标率为40.36%,转铁蛋白饱和度、铁蛋白达标率分别为76.78%、38.95%;(2)Hb达标组与未达标组相比,透析龄、每周重组人促红细胞生成素使用剂量、营养评估体质指数(subjective global assessment,SGA)、血磷水平显著低于未达标组(P<0.05);达标组血清白蛋白、胆固醇、血钙、血清铁、转铁蛋白饱和度、总肌酐清除率(creatinine clearance rate,Ccr)、残肾Kt/V、残肾Ccr显著高于未达标组(P<0.05);(3)高转运组与低平均转运组、高平均转运组相比血红蛋白水平差异具有统计学意义;(4)单因素logistic回归分析显示透析龄>1年、高SGA评分、血清白蛋白<35 g/L、全段甲状旁腺素(intact parathyroid hormone,iPTH)>300 ng/L、血钙>2.5 mmol/L、血清铁<10.6μmol/L、转铁蛋白饱和度<20%、无残余肾功能是PD患者Hb不达标的影响因素;(5)多因素Logistic回归分析结果显示透析龄>5年、血清白蛋白<35 g/L、iPTH>800 ng/L、血清铁<10.6μmol/L、转铁蛋白饱和度<20%为PD患者贫血的独立危险因素。结论高透析龄、低白蛋白水平、甲状旁腺功能亢进、铁缺乏为PD患者贫血的独立危险因素。Objective To explore the hemoglobin level and its related factors in patients on peritoneal dialysis(PD).Methods From May 1,2019 to September 30,2019,280 patients initiated PD and continued it for≥3 months with complete follow-up data.The percentage of patients with Hb levels reaching the guideline target(Hb≥110 g/L)and associated factors of Hb were analyzed.Results Mean Hb concentration was(106.08±20.42)g/L and the rate of target-attaining for hemoglobin 40.36%.The rate of targets for ferroprotein(200-500μg/L),transferrin saturation(≥20%)were 76.78%and 38.95%.Compared with non target-hemoglobin group,target-hemoglobin group had significant statistical differences of dialytic duration,dose of recombinant human erythropoietin,subjective global assessment,serum phosphate,blood calcium,serum albumin,serum iron,ransferrin saturation,cholesterol level and residual renal function(P<0.05).Compared with high transport group,high average transport and low average transport groups had statistically different level of hemoglobin.Univariate logistic regression analysis revealed that duration of dialysis therapy>1 year,subjective global assessment,serum albumin<35 g/L,parathyroid hormone>300 ng/L,blood calcium>2.5 mmol/L,serum iron<10.6μmol/L and transferrin saturation<20%.Multivariate Logistic regression analysis revealed that duration of dialysis therapy≥5 years,serum albumin<35 g/L,intact parathyroid hormone>800 ng/L,serum iron<10.6μmol/L and transferrin saturation<20%were independent risk factors of anemia in PD patients.Conclusion Advanced dialysis age,hypoalbuminemia,hyperparathyroidism and iron deficiency are independent influencing factors of hemoglobin level in PD patients.

关 键 词：腹膜透析 贫血 血红蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]