腹膜透析患者不同补铁方式与腹膜透析相关腹膜炎发生的关系  

Relationship between different iron supplementation and peritoneal dialysis-related peritonitis

作　　者：向子猷 闫嘉 邹思沫 李璐 汪海燕 赖学莉 郭志勇 XIANG Ziyou;YAN Jia;ZOU Simo;LI Lu;WANG Haiyan;LAI Xueli;GUO Zhiyong(Department of Nephrology,Changhai Hospital,the First Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学附属第一医院长海医院肾内科,上海200433

出　　处：《中华实用诊断与治疗杂志》2023年第11期1101-1105,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(82070692)。

摘　　要：目的比较采用静脉补铁、口服补铁的腹膜透析合并肾性贫血患者腹膜透析相关腹膜炎发生情况,探讨补铁方式与腹膜透析相关腹膜炎的关系。方法2008年1月—2018年12月海军军医大学第一附属医院行持续性不卧床腹膜透析合并肾性贫血患者706例,静脉给予右旋糖酐铁者128例为静脉铁剂组,口服琥珀酸亚铁者578例为口服铁剂组,2组均联合应用重组人促红细胞生成素。采用倾向性评分匹配对2组进行1∶3匹配。比较2组匹配前及匹配后性别比例、年龄、腹膜透析持续时间、原发病、合并症情况。随访终止事件为转换透析方式、肾移植、死亡或失访。记录匹配后2组<45岁、45~65岁、>65岁者腹膜炎发生情况。采用多因素logistic回归分析腹膜透析合并肾性贫血患者发生腹膜透析相关腹膜炎的危险因素。结果(1)倾向性评分匹配前,静脉铁剂组男性比率(46.09%)、慢性肾小球肾炎比率(33.59%)均低于口服铁剂组(53.91%、50.00%)(χ^(2)=5.634,P=0.018;χ^(2)=5.767,P=0.016),年龄[(60.32±13.95)岁]大于口服铁剂组[(52.57±16.16)岁](t=9.367,P<0.001),腹膜透析持续时间[59.7(22.70,91.73)个月]长于口服铁剂组[31.35(14.40,54.23)个月](U=7.112,P<0.001),良性小动脉性肾硬化(37.50%)、糖尿病肾病比率(24.22%)均高于口服铁剂组(21.63%、15.74%)(χ^(2)=14.273,P<0.001;χ^(2)=5.265,P=0.022)。(2)倾向性评分匹配后静脉铁剂组102例,口服铁剂组249例。倾向性评分匹配后,2组年龄、腹膜透析持续时间、原发病及合并症与口服铁剂组比较差异均无统计学意义(P>0.05)。(3)倾向性评分匹配后,静脉铁剂组发生腹膜透析相关腹膜炎123次,发生率为0.291次/患者年。口服铁剂组249例发生腹膜透析相关腹膜炎171次,发生率为0.180次/患者年。2组腹膜透析相关腹膜炎发生率比较差异无统计意义(χ^(2)=1.536,P=0.264)。(4)倾向性评分匹配后,静脉铁剂组<45岁、45~65岁、>65岁者各15Objective To compare the incidence of peritoneal dialysis-related peritonitis after intravenous iron supplementation versus oral iron supplementation in patients with renal anemia,and to explore the relationship between iron supplementation and peritoneal dialysis-related peritonitis.Methods A total of 706 patients with renal anemia underwent continuous ambulatory peritoneal dialysis in the First Affiliated Hospital of Naval Medical University from January 2008 to December 2018,among whom 128 patients were given intravenous iron dextran(intravenous iron group)and 578 patients were given oral iron succinate(oral iron group)besides recombinant human erythropoietin in two groups.Propensity score matching was used to perform a 1:3 matching between two groups.The gender ratio,age,duration of peritoneal dialysis,primary diseases and complications were compared between two groups before and after matching.The end events of follow-up included dialysis conversion,renal transplantation,death and loss to follow-up.After matching,the patients in two groups were divided into<45,45-65 and>65 years old groups,and the occurrence of peritonitis was recorded.Multivariate logistic regression was used to analyze the risk factors of peritoneal dialysis-related peritonitis in patients with renal anemia undergoing peritoneal dialysis.Results(1)Before propensity score matching,the proportions of male patients and chronic glomerulonephritis were lower in intravenous iron group(46.09%,33.59%)than those in oral iron group(53.91%,50.00%)(χ^(2)=5.634,P=0.018;χ^(2)=5.767,P=0.016),the patients were older in intravenous iron group[(60.32±13.95)years old]than in oral iron group[(52.57±16.16)years old](t=9.367,P<0.001),the duration of peritoneal dialysis was longer in intravenous iron group[59.7(27.70,91.73)months]than that in oral iron group[31.35(14.40,54.23)months](U=7.112,P<0.001),and the proportions of benign arteriolar nephrosclerosis and diabetic nephropathy were higher in intravenous iron group(37.50%,24.22%)than those in oral iron gr

关 键 词：腹膜透析 肾性贫血 腹膜透析相关腹膜炎 口服铁剂 静脉铁剂 

分 类 号：R692[医药卫生—泌尿科学] R556[医药卫生—外科学]