CKDⅢ～Ⅴ期糖尿病肾病患者贫血特点分析

目的分析慢性肾脏病（CKD）Ⅲ～Ⅴ期糖尿病肾病患者贫血发病率及贫血严重程度。方法收集106例2型糖尿病肾病CKDⅢ～Ⅴ期患者（DN组）、100例非糖尿病肾痛CKDⅢ～Ⅴ期患者（非DN组）及75例肾功能正常2型糖尿痛患者（DM组）的临床资料。对比分析患者的基本临床特征、血常规、生化及超声心动图参数。结果DM组贫血发病率16％，DN组总的贫血发病率为66％，非DN组总的贫血发病率51％（66％vs．51％，P〈0．05）。在CKDⅢ期，DN组与非DN组贫血发病率差异无统计学意义，在CKDⅣ、Ⅴ期，DN组比非DN组贫血发病率高，差异有统计学意义（P〈0．05）。DM组血红蛋白（Hb）高于DN组及非DN组。在CKDⅢ、Ⅳ期患者中，DN组Hb明显低于非DN组，差异有统计学意义（P〈0．05）。而在CKDⅤ期中，DN组与非DN组Hb比较，差异无统计学意义。DN组心血管发病率明显高于非DN组，相关分析显示Hb水平与肾小球滤过率、白蛋白呈正相关，与C反应蛋白呈负相关。结论糖尿病肾病CKDⅢ～Ⅴ期患者贫血发病率高，发生早，贫血程度重，是心血管疾病重要危险因素，应早期纠正贫血，减少心血管事件发生，提高患者生存质量。

Objective To analyze the prevalence and severity of anemia in diabetic nephropathy patients with CKD from stages 3 to 5. Methods We enrolled 281 patients with：（1）type 2 diabetes patients without CKD （DM group, n=75）;（2）diabetic nephropathy patients with CKD from stages 3 to 5 （DN group, n=106）;（3）non-diabetes nephropathy patients with CKD from stages 3 to 5 （non-DN group, n=100）.Values of three groups were analyzed and compared such as the basic clinical characteristic, blood routine, blood biochemical examination and echocardiographic parameters etc. Results Anemia was observed in 16% of the DM group;It was more frequent in the DN group than the non- DN group （66% vs.51%,P〈0.05）.Among patients with CKD from stages 4 to 5, The prevalence of anemia in the DN group was significantly higher in the non-DN group, but the difference was not significant among patients with CKD of stage 3.In the DM group, the levels of hemoglobin were higher than in the DN group and the non- DN group, but the DN group showed lower hemoglobin than the non-DN group at stage 3 and stage 4 of CKD. The difference was not significant among patients with CKD of stage 5. Meanwhile the cardiovascular events in the DN group occurred more frequently, compared to the non-DN group. Furthermore, We also found that the level of Hb was positively correlated with glomerular filtration rate（GFR） and albumin（Alb）, but negatively correlated with C reactive protein（CRP）. Conclusion Compared to non-diabetic nephropathy patients, anemia ocurrs earlier and more frequently in CKD from stages 3 to 5 with diabetic nephropathy patients, which can potentially be associated with cardiovascular events. Therefore, to enhance the wellbeing of the patients and reduce the likelihood of cardiovascular events, a key step is to identify anemia of CKD with diabetic nephropathy patients as early as possible so that they will be timely treated.