2013年昆山地区血液透析患者现状的单中心调查

Epidemiological investigation of maintenance hemodialysis patients in 2013 in a single center in Kunshan arin area

目的通过对2013年8月昆山第一人民医院患者的横断面调查,了解MHD患者的现状。方法收集2013年8月在江苏大学附属昆山医院血透室透析龄大于3个月的患者共242例,分析患者年龄、性别、透前肌酐、透析龄、血红蛋白、血清钙、磷水平、钙磷乘积、全段甲状旁腺激素(iPTH)结果,并进行统计分析。结果 242例患者中,男134例(占55.4%),女108例(占44.6%),男女比例为1.24:1;原发病构成上,前3位分别为慢性肾小球肾炎132例(54.54%),糖尿病肾病25例(10.33%),高血压肾损害19例(7.85%),其中不能明确原发病因者39例(16.11%);Hb<110 g/L 148例(61.16%);206例(85.12%)存在钙磷代谢紊乱(包括高钙、低钙、高磷、低磷的患者),96例(39.66%)钙磷乘积>4.52mmol2/L2。在接受iPTH检查的236例患者中,iPTH<150 ng/L有78例(33.05%),PTH>600 ng/L有32例(13.56%)。结论本中心患者男性略多于女性,尿毒症发病年龄趋于年轻化,慢性肾小球肾炎仍是终末期肾脏病(end stage renal disease,ESRD)的第1位原因;Hb达标率低,相当多的MHD患者存在钙磷代谢紊乱及继发性甲状旁腺激素机能亢进。

Objective To investigate the present situation of maintenance hemodialysis （MHD） patients,we conducted a cross-sectional study on the MHD patients treated in the First People＇s Hospital of Kunshan in 2013.Methods We studied 242 patients treated with MHD in the hemodialysis center in this hospital for more than 3 months during August,2013.Their age,gender,dialysis age,Hb,renal function,serum Ca,serum phosphate,Ca×P product and serum iPTH were recorded and analyzed.Results In the 242 MHD patients,134 were males （55.4％） and 108 were females （44.6％）,with the male to female ratio of 1.24∶1.The predominant disease leading to end-stage renal diseases （ESRD） and MHD was chronic glomerulonephritis （54.54％）,followed by diabetic nephropathy （10.33％）,and hypertensive renal damage （7.85％）.Hb ＜110g/L was found in 148 patients （61.16％）,abnormal metabolism of calcium and phosphorus including hypercalcemia,hypocalcemia,hyperphosphatemia and hypophosphatemia in 206 patients （85.12％）,and Ca×P product ＞ 4.52 in 96 patients （39.66％）.In the 236 patients whose serum iPTH levels were examined,serum iPTH ＜150 was found in 78 patients （33.05％）,and PTH ＞600 ng/L in 32 patients （13.56％）.Conclusions In this cohort of MHD patients,males were slightly more than females,the uremic patients tended to be younger in recent years,and the leading cause of ERSD was chronic glomerulonephritis.A large part of MHD patients were found to have Hb level lower than the standard range,abnormal calcium and phosphorus metabolism,and secondary hyperparathyroidism.