山西省维持性血液透析患者贫血发生情况的流行病学调查及相关因素分析

Epidemiological investigation and analysis of related factors about anemia of patients with maintenance hemodialysis in Shanxi Province

目的了解山西省维持性血液透析(maintenance hemodialysis,MHD)患者贫血的患病率及治疗情况,并研究其影响因素。方法通过全国血液净化病例登记系统采集2017年山西省网上直报的MHD患者的临床资料,包括基本资料、透析情况、药物治疗情况及实验室指标,以血红蛋白(hemoglobin,Hb)≥110 g/L作为治疗靶目标,整理并分析数据。结果2017年山西省MHD患者平均Hb水平为(107.2±19.2)g/L,Hb总体达标率为45.7%。红细胞生成刺激剂使用率为97.6%,铁剂使用率为35.5%,其中68.0%的患者使用静脉铁剂。性别分层显示男性Hb达标率好于女性,年龄分层显示随着年龄的增长,Hb达标率呈增高趋势。与Hb未达标组相比,Hb达标组患者男性比例、平均年龄、透析龄、使用进口透析器的人数比例、尿素下降率及尿素清除分数、静脉铁剂使用率、左旋肉碱使用率、碳酸氢根、血白蛋白、甘油三脂较高;原发病为高血压病患者比例、每周红细胞生成刺激剂剂量、转铁蛋白饱和度≤30%患者比例、甲状旁腺素及C反应蛋白较低(均P<0.05)。多因素Logistic回归分析显示,男性、静脉补铁、高血白蛋白为Hb达标的保护因素,而高甲状旁腺素、高C反应蛋白为Hb达标的危险因素。结论山西省MHD患者Hb总体达标率(Hb≥110 g/L)为45.7%。男性、静脉补铁、高白蛋白可能为Hb达标的保护因素,高甲状旁腺素、高C反应蛋白可能为其危险因素。合理使用静脉铁剂、改善营养状态,纠正炎症反应可提高Hb达标率。

Objective To investigate the prevalence and treatment of anemia in maintenance hemodialysis(MHD)patients in Shanxi Province,and to study the influencing factors.Methods Clinical data of MHD patients reported online in Shanxi Province in 2017 were collected through the National Blood Purification Registration System,including basic data,dialysis status,drugs treatment,and laboratory indicators.Hemoglobin(Hb)≥110 g/L was taken as the goal of treatment.The data collected were then sorted out and analyzed.Results In 2017,the average Hb level of MHD patients in Shanxi Province was(107.2±19.2)g/L,and 45.7%patients reached the goal level.The utilization rate of erythropoiesis stimulating agents(ESAs)was 97.6%.The utilization rate of iron agent was 35.5%,of which 68.0%was intravenous use.The gender stratification showed that male patients had a higher percentage in meeting the Hb goal than females.Age stratification showed that with the increase of age,the Hb goal rate had an increasing trend.Compared with the Hb<110 g/L group,the Hb≥110 g/L group had more male patients,higher average age,higher dialysis age,more use of import dialyser,higher urea reduction rate and higher clearance rate,more use of intravenous iron,more use of L-carnitine,higher HCO3-level,higher albumin level,and higher triglycerides level(all P<0.05).Compared with the Hb<110 g/L group,the Hb≥110 g/L group,however,had less patients with hypertension as primary disease,lower dose of ESA,less patients with transferrin saturation≤30%,and lower levels of parathyroid hormone and C-reactive protein(all P<0.05).The multi-factor logistic regression analysis showed that male gender,intravenous iron use,and high level of albumin were the protective factors for the Hb goal,while parathyroid hormone and Creactive protein were the risk factors.Conclusions The overall rate of Hb≥110 g/L in the MHD patients of Shanxi Province was 45.7%.Male gender,intravenous iron use,and high level of serum albumin may be protective factors,while parathyroid hormone and C-reactive protein may be the risk factors.Rational use of intravenous iron agents,improvement of nutritional status,and reduction of inflammatory reactions may improve the Hb level of the patients.