初始腹膜透析患者铁代谢及其影响因素分析  

Iron status and its influencing factors in patients on incident peritoneal dialysis

作　　者：彭宇浩 唐静[3] 尹清华 曾筱茜[2] PENG Yuhao;TANG Jing;YIN Qinghua;ZENG Xiaoxi(Suzhou Medical College,Soochow University,Suzhou 215000,Jiangsu,China;West China Biomedical Big Data Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Nephrology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]苏州大学医学院,江苏苏州215000 [2]四川大学华西医院华西生物医学大数据中心,四川成都610041 [3]四川大学华西医院肾脏内科,四川成都610041

出　　处：《西部医学》2023年第7期1068-1073,共6页Medical Journal of West China

基　　金：四川省科技厅课题(2021YJ0219,2021YFQ0035)。

摘　　要：目的 探讨初次行腹膜透析(PD)的终末期肾病患者铁代谢和铁缺乏(ID)情况,分析其可能的影响因素。方法 纳入2011年1月—2018年1月在四川大学华西医院初次行PD的患者633例,根据是否缺铁分为ID组(n=256)和Non-ID组(n=377),采集开始透析后1~3月内初次行PD评估时的铁代谢指标、生化指标和透析指标等临床资料。对铁代谢指标血清铁蛋白(Fer)、转铁饱和度水平(TSAT)和不同ID情况进行分析,并通过相关分析和回归分析探索影响铁代谢指标的相关因素和独立影响因素。结果 纳入患者平均Fer水平(277.9±278.1)μg/L,TSAT水平(29.9±12.9)%。41.0%患者存在相对性铁缺乏,15.5%绝对性铁缺乏(AID),7.9%功能性铁缺乏(FID)。Fer和TSAT达标率分别为50.7%和69.5%。Fer和TSAT均与性别相关,与血小板计数和炎症因子等负相关。血清铁蛋白还与糖尿病和使用EPO相关。多元线性回归分析显示女性、低血清白蛋白、低血小板计数和高敏C反应蛋白(hsCRP)是Fer水平降低的独立影响因素;低血小板计数、糖尿病和高白介素6(IL-6)是TSAT降低的独立影响因素。结论 初始腹膜透析患者中铁缺乏者并不少见。女性、血小板增多、糖尿病和炎症是铁储备或铁利用降低的独立影响因素。在腹膜透析初期即应针对可能的危险因素,制定合理的补充铁剂的治疗方案。Objective To investigate the iron status and iron deficiency in incident peritoneal dialysis(PD)patients and discuss the possible influencing factors.Methods From January 2011 to January 2018,the patients with started peritoneal dialysis with end-stage renal disease were enrolled.The clinical data of iron metabolism,biochemical and dialysis parameters during the first peritoneal dialysis evaluation were collected.The levels of serum ferritin and transferrin saturation were evaluated,and their independent influencing factors were explored by correlation analysis and regression analysis.Results Of 633 adult PD patients,40.4%had iron deficiency,15.5%absolute iron deficiency and 7.9%functional iron deficiency.The average serum ferritin level was 277.9±278.1ug/l,and the iron saturation 29.9±12.9%.50.7%and 69.5%patients reached respectively target serum ferritin level and iron saturation recommended by Chinese Society of Nephrology.Serum ferritin level and transferrin saturation were not correlated with eGFR,but negatively correlated with platelet count and inflammatory factors.The results of multiple linear regression analysis showed that women,low serum albumin,high platelet count and high hsCRP level were the independent influencing factors of lower ferritin level,while high platelet count,presence of diabetes mellitus and high IL-6 level were the independent influencing factors of lower transferrin saturation.Conclusion Iron deficiency is not uncommon in patients on incident peritoneal dialysis.Women,thrombocytosis,diabetes and inflammation are risk factors of iron storage or reduced iron utilization.In initial stage of peritoneal dialysis,a reasonable iron supplement strategy should be established on PD patients with risk factors.

关 键 词：腹膜透析 铁蛋白 转铁蛋白饱和度 铁缺乏 

分 类 号：R692[医药卫生—泌尿科学]