老年患者慢性病贫血病因分析、诊断探讨及研究展望(附85例分析)

Clinical Analysis of 85 cases of anemia of chronic disease in senile patients

目的:研究老年人慢性病贫血的病因、临床表现及诊断,提高对老年患者慢性病贫血的认识。方法:收集85例老年贫血患者临床资料及实验室检查结果。回顾性分析该85例患者的入院诊断、血常规及铁代谢的研究。结果:85例慢性病贫血患者中:慢性病贫血合并缺铁性贫血50例(58.82%),合并肾性贫血16例(18.82%),合并叶酸、维生素B12缺乏者19例(22.36%)。85例患者中贫血严重程度上:轻度贫血46例(54.12%),中度贫血34例(40%),重度贫血5例(5.88%);形态分类:大细胞性贫血5例(5.88%),正常细胞性贫血75例(88.24%),小细胞低色素性贫血5例(5.88%);铁代谢:血清铁浓度降低者50例(58.82%),正常者21例(24.71%),升高者14例(16.47%)。总铁结合力降低者51例(60%),正常者15例(17.65%),升高者19例(22.35%)。转铁蛋白饱和度降低者14例(16.47%),正常者71例(83.53%)。血清铁蛋白正常或增高。基础疾病:感染68例(80.00%),高血压60例(70.59%),脑血管疾病58例(68.24%),冠心病57例(67.06%),糖尿病33例(38.82%),恶性肿瘤17例(20%)。结论:住院老年患者中慢性病贫血的发病率高,但由于老年患者患有多种疾病,贫血症状往往被原发疾病所掩盖,漏诊率极高。及时诊断并治疗慢性病贫血对高龄老人的基础疾病的治疗有较好的效果。

Objective To investigate the etiology,clinical manifestations and diagnosis of anemia of chronic disease（ ACD）in senile patients and to raise the awareness of ACD. Method To gather the clinical data and laboratory test results of eighty-five cases of ACD in totally 286 cases of senile patients,to retrospective analysis of admission diagnosis,blood and iron metabolism of the eighty -five ca-ses. Results The total incidence of ACD in in-patients was 29. 72%,but only 3 cases were diagnosed as ACD in their discharge diagno-sis,the missed diagnosis rate was 96. 50%. Among them,chronic anemia associated with iron deficiency anemia accounted for 50 cases （58. 82%）,combined accounted for 16 cases（18. 82%）of renal anemia,combined folic acid,vitamin B12 deficiency,19 cases（22. 36%） . Classification by severity of anemia,54. 12% of the cases were mild anemia,40. 00% of which were moderate anemia and 5. 88% of them were serve anemia. In the morphology,5. 88% of them were large cell anemia,88. 24% of which were normal anemia and 5. 88% of the ca-ses were small cell hypochromic anemia. In the iron metabolism,Serum iron concentration decreased by 50 cases（58. 82%）,Normal in 21 cases（ 24. 71% ）,increased in 14 cases（ 16. 47% ）. Total iron binding capacity decreased in 51 cases（ 60% ）,normal in 15 cases （ 17. 65% ）,increased in 19 cases（ 22. 35% ）. Transferrin saturation decreased in 14 cases（ 16. 47% ）,normal in 71 cases（ 83. 53%）. Normal or elevated serum ferritin. 80. 00% of them were caused by infections,70. 59% were due to hypertension,68. 24% of the ACD cases were caused by cerebrovascular diseases,67. 06% were due to coronary heart disease,38. 82% were caused by diabetes,and 20. 00%of which were accompanied by malignance. Conclusion The incidence of ACD in senile in-patients is high but the miss diagnosis rate is also high because the symptoms of anemia is often overshadowed by the primary disease. So timely diagnosis and treatment of anemia of chronic disease has a good effect on the treatment of the underlying disease of the senile patients.