维持性血液透析退出患者铁代谢特点及危险因素分析

Analysis of iron metabolism characteristics and risk factors in patients with maintenance hemodialysis withdrawal

目的 分析退出血液透析患者的铁代谢特点,并进一步探讨影响患者退出血液透析的高危因素。方法 以2011年1月至2014年1月期间本院血液透析患者为研究对象,收集其基本项目、临床资料、实验室检查包括营养状态、炎症反应、铁代谢等临床资料。采用COX回归进行多因素统计学分析。结果 两组患者在年龄、性别、基础病等一般资料方面差异无统计学意义,而退出组总铁结合力明显高于未退出组;多因素回归分析显示总铁结合力增高、血蛋白降低及酸中毒为患者退出透析的独立危险因素。结论 总铁结合力升高是退出透析患者的铁代谢特点,其与低蛋白、酸中毒一起均是血透患者退出透析的独立危险因素。

Objective To analyze the pathological characteristics of iron metabolism in patients who have dropped out hemodialysis,and risk factors.Methods A 3-year research was conducted at the kidney disease centre of our hospital to determine the risk factors which affect the life quality of maintenance hemodialysis(MHD)patients.The clinical data such as iron metabolism and biochemical indicators were examined among 169 patients with end-stage renal disease(ESRD).Results Of 169 patients with MHD,30 cases quitted dialysis due to various adverse outcomes(death,transfer to peritoneal dialysis),and the other 139 cases were still in our centre to receive hemodialysis.The serum ferritin increased in both groups,while the changes of serum total iron-binding capacity(TIBC),blood albumin level,and carbon dioxide binding force were significantly different.The COX regression analysis showed that the TIBC,albumin,and carbon dioxide binding force were the independent factors which influenced the life quality of dialysis patients.Conclusion The detection of iron parameters in MHD patients should be strengthened,the intravenous iron treatment should be carefully conducted,and doctors should correct malnutrition and maintain the electrolyte and acid-base balance clinically for MHD patients,in order to improve their life quality.