安徽省维持性血液透析患者贫血患病率及血红蛋白达标率的流行病学调查

Epidemiological investigation on the prevalence of anemia and the standardreaching rate of hemoglobin in patients with maintenance hemodiaiysis in Anhui province

目的调查安徽省维持性血液透析（MHD）患者贫血患病率、血红蛋白达标率及影响血红蛋白达标因素。方法纳入2014年1月1日至2014年03月31日期间在安徽省皖南、皖中、皖北13市26家医院行MHD的成年患者2601例。收集患者年龄、性别、原发病、透析龄、透析方式、药物使用及实验室检查等资料，以浓度≥110g／L为血红蛋白达标标准，分析贫血患病率、血红蛋白达标率及影响血红蛋白达标因素。结果（1）安徽省MHD患者血红蛋白平均浓度为（100．2±28．1）gm，贫血患病率为82．5％，红细胞生成素使用率为95．2％，铁剂使用率为64．3％，叶酸使用率为62．0％。（2）MHD患者血红蛋白达标率为32．8％，男性患者中血红蛋白达标率高于女性（35．1％比29．4％，P=0．002），高通量透析患者血红蛋白达标率高于低通量透析患者（39．2％比27．9％，P〈0．001）。（3）与血红蛋白达标患者比较，血红蛋白未达标患者女性比例高，透析龄短，血清白蛋白、肌酐、三酰甘油、钙、磷、镁水平低，而血清超敏c反应蛋白明显增加，红细胞生成素、铁剂和叶酸使用率均增加（均P〈0．05）。（4）多因素Logistic回归分析发现，2．10—2．50mmol／L钙（OR=O．346，P=0．005）、〉2．50mmol／L钙（OR=0．207，P=0．001）、〉41．9g／L白蛋白（OR=0．511，P=0．044）、1．11～2．01mmol／L三酰甘油（OR=0．443，P=0．008）、〉2．0lmmol／L三酰甘油（OR=0．257，P〈0．001）及≥7．63mg／L超敏C反应蛋白（OR=1．652，P=0．049）可能是血红蛋白未达标的影响因素。结论安徽省MHD患者贫血患病率高，血红蛋白达标率低；达标钙、高钙、高白蛋白及三酰甘油可能为影响血红蛋白达标的保护因素，而高超敏C反应蛋白可能为其独立危险因素。因此，充分透析、改善营养状态、纠正钙磷代谢紊乱和微炎性反应等，可能提高血红蛋白达标率。

Objective To explore the prevalence of anemia, percentage of patients with hemoglobin （Hb） reaching the guideline target, and its impact factors in maintenance hemodialysis （MHD） patients in Anhui province. Methods Two thousand six hundred and one cases of MHD patients were investigated in hemodialysis centers of 26 hospitals in southern, northern and central Anhui province from January 1st, 2014 to March 31st, 2014. Age, gender and clinical information on renal disease history, duration of dialysis therapy, types of dialysis, medical history, and laboratory results, were collected. The prevalence of anemia, percentage of patients with Hb levels reaching the guideline target （Hb≥110 g/L） and the associated factors of Hb were analyzed. Results （1） Mean Hb concentration was （100.2：t28.1） g/L, 82.5% of patients were diagnosed as anemia. The use rate of erythropoietin, intravenous iron and folic acid were 95.2%, 64.3% and 62.0% respectively. （2） Hb≥ 110 g/L rate was 32.8%. The percentage of patients with Hb≥110 g/L was higher in males than that in females （35.1% vs 29.4%, P=0.002）. Patients with high flux dialysis had a higher percentage of Hb≥ 110 g/L than those with low flux dialysis （39.2% vs 27.9%, P 〈 0.001）. （3） Compared with patients whose Hh≥110 g/L, patients with 〈 110 g/L had shorter duration of dialysis therapy, lower albumin, creatinine, triglyceride, calcium, phosphorus, magnesium, and higher hs- CRP, higher usage rates of erythropoietin, intravenous iron and folic acid （all P 〈 0.05）. （4） The 2.10-2.50 mmol/L calcium （OR= 0.346, P=0.005）, 〉 2.50 mmol/L calcium （OR=0.207, P=0.001）, 〉 41.9 g/L albumin （OR=0.511, P= 0.044）, 1.11- 2.01 mmol/L triglyceride （OR=0.443, P=0.008）, 〉 2.01 mmol/L triglyceride （0R=0.257, P 〈 0.001） and ≥7.63 mg/L hs-CRP （OR=1.652, P=0.049） were influence factors causing Hb to fall below. Conclusions There are high prevalence of anemia and low control rate of hemoglobin in MHD patients in Anhui province. Normal-calcium, hypercalcemia, higher albumin and triglyceride are protective factors of Hb target, but higher hs-CRP is its independent risk factors. The rational use of erythropoietin and intravenous iron, high flux dialysis, well nutrition states, correcting of the hypocalcemia and inflammatory state may contribute to improving the hemoglobin levels.