低蛋白血症和贫血对维持性血液透析患者再入院的影响

Influence of hypoproteinemia and anemia on readmission in maintenance hemodialysis patients

目的探讨低蛋白血症和贫血对维持性血液透析患者发生再入院的影响。方法回顾性分析了2005年4月至2008年4月在我院进行维持性血液透析3个月以上,发生两次或两次以上入院的患者78例,并随机选取同期非再入院的维持性血液透析患者60例作为对照组。记录患者发生再入院的病因,检测血白蛋白、前白蛋白、血红蛋白、胆固醇、血尿素氮、血清肌酐、铁蛋白、总铁结合力、钙、磷等指标。结果维持性血液透析患者发生再入院的病因主要为感染(42.3%)、消化道症状(18.0%)和心血管疾病(15.4%)。经统计学分析,再入院组白蛋白、前白蛋白、血红蛋白水平明显低于非再入院组(P<0.01)。低水平前白蛋白和血红蛋白是患者再入院的独立危险因素,前白蛋白每降低1 mg/L,再入院风险增加2.2%,血红蛋白每降低1 g/L,再入院风险增加7.6%。结论低蛋白血症和贫血增加维持性血液透析患者再入院的发生率。

Objective To investigate the influence of hypoproteinemia and anemia on readmission of maintenance hemodialysis patients. Methods Retrospective study was made on the clinical data of 78 cases of admission ≥ two times from April 2005 to April 2008 and the simultaneous non-readmission 60 outpatients were randomly chosen as control group. The reason leading to readmission was recorded. Biochemical parameters including serum albumin, prealbumin,hemoglobin, cholesterol, serum urea nitrogen, creatinine, ferritin, total iron binding capacity （TIBC）, calcium,phosphorus were detected. Results The reason leading to readmission included mainly infection （42.3%）, digestive symptoms（18.0 % ）, cardiovascular disease（15.4 %）. The statistics analysis showed that the levels of serum albumin,prealbumin and hemoglobin of readmission group were significantly lower than those of control group（ P 〈0.01）. Multivariate logistic regression analysis showed that the low level of prealbumin and hemoglobin were the independent risk factors of readmission. As the level of prealbumin decreased 1 mg/L, the readmission rate increased 2.2%, and the level of hemoglobin decreased 1 g/L, the readmission rate increased 7.6%. Conclusion Hypoproteinemia and anemia increase the readmission rate in maintenance hemodialysis patients.