维持性腹膜透析与血液透析患者血红蛋白变异性的对比研究

Comparative study of hemoglobin variability between maintenance peritoneal dialysis and hemodialysis

目的回顾性分析比较维持性腹膜透析(简称腹透)患者及血液透析(简称血透)患者血红蛋白(Hb)水平及血红蛋白变异性(Hb-Var)的差异,探讨影响Hb-Var的可能因素。方法选取成都市第三人民医院2011年1月至2013年4月终末期肾病进行维持性透析(包括血透及腹透)患者90例,观察9个月内患者的Hb、铁指标水平及重组人红细胞生成素(EPO)用量。进行Hb围绕目标值的分组及计算Hb余标准差(Res-SD)来表示Hb-Var,观察维持性腹透患者及血透患者Hb-Var,并分析9个月期间患者使用EPO剂量的变化以及透析前后C-反应蛋白(CRP)指标的变化,使用二分类Logstic回归分析方法分析Hb-Var与性别、年龄、透析方式、基线Hb、EPO剂量、EPO剂量波动、铁蛋白水平及血清白蛋白之间的关系。结果血透患者透析后CRP较透析前明显升高(P<0.001),而腹透前后的CRP无明显变化。同期比较血透组使用的EPO剂量明显高于腹透组。围绕Hb目标值两组分布结果相似,血透腹透均围绕目标值下限波动最多,两组无统计学差异(P>0.05),血透患者的Res-SD显著高于腹透患者(P=0.014),影响Hb-Var的相关因素有EPO剂量的波动和血透方式。结论血透患者较腹透患者的EPO使用量更大、血红蛋白变异性更为显著,EPO剂量的波动及透析方式是影响Hb-Var的独立危险因素。

Objective Compare the difference of hemoglobin level and hemoglobin variability（Hb-Var） between stable peritoneal dialysis（PD） patients and hemodialysis（HD） patients with retrospective analysis, explore the possible factors which affect Hb-Var. Methods Ninety patients of end-stage renal disease treated with maintenance dialysis（including HD and PD） from January 2011 to April 2013 in Chengdu Third People＇s Hospital were selected in this study, observe patients＇ hemoglobin（Hb）, iron index level and recombinant human erythropoietin（EPO） dosage in 9 months. Hb Res-SD was calculated to represent the Hb-Var, Hb-Var of maintenance PD and HD patients was observed, the changes of EPO dose and the CRP indexes were analyzed before and after dialysis during the nine months, the relationship between Hb-Var and gender, age, dialysis, baseline Hb, EPO dose, EPO dose fluctuations, ferritin level and serum albumin were analyzed by dichotomy logistic regression analysis. Results CRP of HD increased more significantly after dialysis（P〈0.001）, while there was no significant changes before and after PD. At the same time, the usage of EPO dose in HD group was obviously higher than that in PD group. Around Hb target, the distribution results of two groups was similar, HD and PD group fluctuates mostly around the target lower limit, which had no statistical differences（P〉0.05）, Res-SD of HD group was obviously higher than that in PD group（P=0.014）. The related factors influenced the Hb-Var include fluctuations of EPO dose and manner of HD. Conclusion The usage of EPO in patients with HD is bigger and Hb-Var is more significant than those in PD. The volatility of EPO dose and the manner of dialysis are independent risk factors which affect Hb-Var.