维持血液透析患者血红蛋白达标情况分析

Hemoglobin level analysis in hemodialysis patients

目的了解维持血液透析患者贫血治疗达标情况并分析其影响因素。方法选择我院规律血液透析患者73例。按血红蛋白(hemoglobin,Hb)水平将患者分为3组:A组为Hb≥130 g/L患者;B组为110 g/L≤Hb<130g/L患者;C组为Hb<110 g/L患者。透析前采血检测肾功能、血常规、电解质、白蛋白(albumin,Alb)、C反应蛋白(C-reactive protein,CRP)、β2-微球蛋白(β2-microglobulin,β2-MG)、血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血清铁蛋白(serum ferritin,SF)等参数。记录最近4周重组人红细胞生成素(recombinant human erythropoietin,r-HuEPO)的应用总量,以每周应用总量同红细胞压积(hematocrit,Hct)的比值(r-HuEPO dosage to Hct,EPO/Hct)作为评价r-HuEPO低反应的指标。比较3组患者上述指标的差别,分析各因素与Hb的相关性。结果①73例患者中,Hb≥110 g/L者62例,占全部患者的84.93%。②EPO/Hct比值,B组患者明显高于A组患者(P<0.05)。③C组患者EPO/Hct比值、CRP、β2-MG及iPTH水平均高于A组和B组(P<0.05)。④其余各项指标三组间差异无统计学意义(P>0.05)。⑤单因素相关分析,Hb与ALB呈显著正相关(P<0.05);与EPO/Hct、β2-MG、CRP及iPTH呈显著负相关(P<0.05)。⑥多因素逐步线性回归分析:EPO/Hct、CRP、Alb和β2-MG是Hb的独立影响因素[标准回归系数(Beta)分别为-1.607,-3.391,0.612,-1.019]。结论 r-HuEPO低反应性是贫血治疗不达标的主要原因,患者微炎症水平、营养状态及中分子毒素的清除不足可能是其危险因素。

Objective To investigate the hemoglobin level in hemodialysis patients and its factors of influence.Methods Seventy-three hemodialysis patients were divided into group A（Hb≥130 g/L）,B（110 g/L≤Hb130 g/L） and C（Hb110 g/L） according to the plasma hemoglobin level.A series of biochemical tests were performed before dialysis such as renal function,blood routine,electrolysis,albumin（Alb）,C-reactive protein（CRP）,β2-microglobulin（β2-MG）,serum intact parathyroid hormone（iPTH） and serum ferritin（SF）.The total applied amount of r-HuEPO in the recent four weeks and the ratio of the applied amount of r-HuEPO per week and Hct were recorded as evaluation indicators of low response for r-HuEPO.These indicators were compared between the three groups;the correlation between these factors and Hb was analyzed.Results ①Sixty-two patients with Hb≥110 g/L accounted for 84.93% of the total patients.②The amount of erythropoietin/hematocrit（EPO/Hct） ratio in group B was higher than that in group A（P0.05）.③EPO/Hct ratio,ALB,CRP,β2-MG and iPTH in group C were higher than those in group A and B respectively.④There was no difference in other indicators between the three groups（P0.05）.⑤By univariate correlation analysis,Alb was positively correlated with Hb.However,EPO/HCT,β2-MG,CRP and iPTH were negatively correlated with Hb（P0.05）.⑥By multivariate stepwise linear regression analysis,Hb level was strongly related to EPO/Hct,CRP,Alb,β2-MG and iPTH.The standard regression coefficient（Beta） was-1.607,-3.391,0.612 and-1.019,respectively.Conclusions The low response for r-HuEPO is the main reason for non-compliance for anemia treatment.The level of micro-inflammation,nutritional status and inadequate removal of toxins may be the risk factors.