维持性血液透析患者血红蛋白波动的临床研究

Clinical research on hemoglobin variability in maintenance hemodialysis patients

目的了解维持性血液透析患者血红蛋白（m）波动情况，初步探讨Hb波动的影响因素。方法选取复旦大学附属中山医院血液透析中心透析龄超过12个月的患者。以Hbll0～120g／L为靶目标值，根据前后两个月的Hb变化值是否达到10gL分为波动组和非波动组。应用多因素Logistic回归分析衄波动的影响因素。结果共163例患者，基线Hb值为（107．52±15．47）g／L，随访期平均lib值为（106．57±15．22）g／L。基线及随访期Hb达标情况大致相似，46．6％-56．4％患者Hb未达标（Hb〈110g／L）。随访期中仅有1．2％患者胁始终达标。患者平均既波动值为8．15±5．01g／L，Hb波动率为27．O％，短期波动在大多数血液透析患者中较常见，少数患者lib长期处于不稳定状态。非波动组患者的透析龄和基础Hb值显著高于波动组（f=-5．032，P=0．048；t=-1．731，P=O．010），促红细胞生成素（EPO）剂量显著低于波动组（t=6．218，P〈0．001）。多因素Logistic回归分析显示，经过透析龄〈24个月、基础Hb〈100g／L等因素校正后，EPO剂量≥200U／（kg·W）与Hb波动显著独立相关（OR=4．7，95％CI3．2-9．3，P=0．030）。结论Hb波动在维持性血液透析患者中普遍存在，少数患者Hb长期处于不稳定状态。Hb波动较大的维持性血液透析患者EPO剂量应用也较大。

Objective To investigate the hemoglobin （Hb） variability in maintenance hemodialysis patients, and analyze the influence factors on Hb fluctuation. Methods Patients undergoing maintenance hemodialysis for over 12 months in Zhongshan Hospital from June 2011 to December 2011 were enrolled. Target value of Hb was 110-120 g/L and hemoglobin fluctuation referred to the fluctuation in Hb ≥ 10 g/L between 2 continuous months. The influence factors on Hb fluctuation were evaluated with multivariate logistic regression analysis. Results In 163 patients enrolled, the baseline Hb value was （ 107.52 ± 15.47） g/L and the 6-month mean Hb was （ 106.57 ± 15.22） g/L. The distributions of Hb were similar before and during the entire follow-up period. Among them, 46.6%-56.4% patients didn＇t reach the Hb target range （Hb 110-120 g/L）. Only 1. 2% patients were always within the target range during the 6 months of follow-up. The average Hb variability was （8.15 ± 5.01 ） g/L and the fluctuation ratio was 27.0%. Short-term fluctuations were common in the majority of hemodialysis patients, but a few patients were with chronic Hb instability. The dialysis age and the basal Hb values of the non-fluctuation group were significantly higher than those of the fluctuation group （ t = - 5. 602, P = 0.048 ; t = - 1. 731, P = 0.010）, and the erythropoietin （EPO） dose was significantly lower than that of the fluctuation group （t = 6. 218, P 〈 O. 001 ）. Multivariate logistic regression analysis showed that, after adjustment by dialysis age 〈 24 monthsand basic Hb 〈 100 g/L, the EPO dose≥200 U/kg/w） remained significantly and independently associated with the Hb variability in patients with maintenance hemodialysis （ OR = 4. 7, 95% CI 3. 2-9. 3, P = 0. 030）. Conclusion Hemoglobin fluctuation is common in patients with maintenance hemodialysis and a few patients are with chronic Hb instability. Patients with substantial Hb fluctuation during maintenance hemodialysis need to use greater doses of EPO.