持续性非卧床腹膜透析肾性贫血患者中医证型分布特征及相关性研究  

Study on the distribution characteristics and correlation of Chinese medicine patterns in patients with CAPD renal anemia

作　　者：葛永 王亿平[2] GE Yong;WANG Yi-Ping(The First Clinical Medical College of Anhui University of Traditional Chinese Medicine,Hefei 230000,Anhui,China)

机构地区：[1]安徽中医药大学第一临床医学院,安徽合肥230000 [2]安徽中医药大学第一附属医院肾内科

出　　处：《吉林医学》2025年第1期14-20,共7页Jilin Medical Journal

基　　金：安徽省中医药领军人才项目[项目编号:皖中医药发展秘(2018)23号];安徽省2021年医疗卫生重点专科建设项目[项目编号:皖卫函(2021)273号];安徽省重点研究与开发计划项目[项目编号:人口健康专项:202104j07020014];安徽省重大疑难疾病中西协同攻关项目[项目编号:皖中医药发展秘(2021)70号];2022年安徽省临床医学研究转化专项[项目编号:202204295107020042]。

摘　　要：目的:探讨持续性非卧床腹膜透析(CAPD)合并肾性贫血患者中医证型分布特征及与各指标的关系。方法:选取292例在安徽中医药大学第一附属医院行CAPD治疗且时间大于3个月患者,收集患者人口学特征及临床资料,依据住院期间是否发生贫血分为肾性贫血组(n=274)和非肾性贫血组(n=292),比较两组性别、年龄、实验室指标等因素的关系,并观察肾性贫血组中医证型分型特征。结果:所有患者中本虚证、标实证分布分别以脾肾气虚证、血瘀证占比最多。透析龄、天门冬氨基转移酶、血白蛋白、血总钙、超敏C反应蛋白、甲状旁腺素、血红蛋白在本虚证中分布情况比较,差异有统计学意义(P<0.05),甲状旁腺素在标实证中分布情况比较,差异有统计学意义(P<0.05)。多元Logistic回归显示,血白蛋白是CAPD合并肾性贫血患者的保护因素,差异有统计学意义(P<0.05),血肌酐是CAPD合并肾性贫血患者的危险因素(P<0.05);受试者工作特征曲线(ROC)显示,血白蛋白预测CAPD合并肾性贫血的最佳截断值为33.95 g/L,曲线下面积(AUC)为0.821,灵敏度为68.6%,特异性为88.9%,差异有统计学意义(P<0.05);血肌酐预测CAPD合并肾性贫血的最佳截断值为638.10μmol/L,AUC为0.722,灵敏度为69.7%,特异性为66.7%,差异有统计学意义(P<0.05);二者联合预测CAPD合并肾性贫血的AUC为0.889,灵敏度为89.9%,特异性为78.8%,差异有统计学意义(P<0.05)。结论:CAPD肾性贫血患者中医证型的分布以脾肾气虚证、血瘀证为主,透析龄、天门冬氨基转移酶、血白蛋白、血总钙、超敏C反应蛋白、甲状旁腺素、血红蛋白在中医证型中的分布具有差异性。血白蛋白、血肌酐可作为预测CAPD患者合并肾性贫血的指标之一,且二者联合检测准确度更高。Objective To investigate the distribution of Chinese medicine patterns in patients with continuous ambulatory peritoneal dialysis(CAPD)combined with renal space anemia,and their relationship with various indicators.Method 292 patients were selected from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine who had been treated with CAPD for more than 3 months,and the demographic characteristics and clinical data of the patients were collected,and they were divided into renal anemia group(n=274)and non-renal anemia group(n=292)according to the occurrence of anemia during the hospitalization period,comparing the relationship between the two groups in terms of gender,age,laboratory indexes,and other factors,and observing the characteristics of the traditional Chinese medicine pattern distribution in the renal anemia group.Results Among all patients,the distribution of this deficiency and the standardized solid evidence were most occupied by spleen and kidney qi deficiency and blood stasis,respectively.There were significant differences in the distribution of dialysis age,aspartate aminotransferase,blood albumin,total blood calcium,ultrasensitive C-reactive protein,parathyroid hormone,and comment hemoglobin in this deficiency evidence(P<0.05)and parathyroid hormone in the standard evidence(P<0.05).Multiple logistic regression showed that blood albumin was a protective factor for patients with CAPD combined with renal anemia(P<0.05),and blood creatinine was a risk factor for patients with CAPD combined with renal anemia(P<0.05);the ROC curve showed that the best cut-off value of blood albumin for predicting CAPD combined with renal anemia was 33.95 g/L,with an AUC of 0.821,sensitivity of 68.6%,and specificity of 88.9%(P<0.05);the best cut-off value of blood creatinine for predicting CAPD combined with renal anemia was 638.10μmol/L,with an AUC of 0.722,sensitivity of 69.7%,and specificity of 66.7%(P<0.05);the combination of the two predicted CAPD combined with renal anemia with an AUC of 0.

关 键 词：持续性非卧床腹膜透析 肾性贫血 中医证型 相关因素分析 

分 类 号：R692[医药卫生—泌尿科学]