影响长期维持性血液透析患者发生肾性贫血的危险因素分析

Analysis of Risk Factors Affecting Renal Anemia Inpatients with Long-term Maintenance Hemodialysis

目的 分析长期维持性血液透析(maintenancehemodialysis,MHD)患者发生肾性贫血的危险因素。方法 按纳入与排除标准筛选2016年1月~2017年12月在三六三医院就治的MHD患者作为研究对象,以查阅临床病例、随访资料等方式采集患者一般临床资料、透析情况、实验室指标等因素,统计肾性贫血患病率,并以此为分组条件,先行单因素分析,再将单因素分析有差异选项纳入多因素Logistic回归分析,明确长期MHD患者发生肾性贫血独立影响因素。结果 227例MHD患者肾性贫血患病率为78.65%,按是否为肾性贫血分组,肾性贫血组174例,其余53例Hb≥110g/L患者纳入对照组;单因素分析显示,2组仅身体质量指数(BMI)、红细胞计数(RBC)、白蛋白、血钙、白细胞计数(WBC)、红细胞压积(Hct)、血小板计数(PLT)、血清铁蛋白(SF)、血清铁(SI)、铁饱和度(ISAT)、总铁结合力(TIBC)、未饱和铁结合力(UIBC)、单池Kt/V(spKt/V)、铁调素、C反应蛋白(CRP)、甲状旁腺激素(iPTH)、叶酸、尿酸(UA)、血肌酐(Scr)比较差异有统计学意义(P<0.05);以肾性贫血为因变量(是=1、否=0),将单因素分析有差异选项纳入多因素Logistic回归模型,结果显示ISAT、TIBC、UIBC、spKt/V、铁调素、CRP、iPTH是MHD患者肾性贫血的独立影响因素。结论 MHD患者肾性贫血患病率高,临床或应重视上述影响因素,积极应对,最大限度降低MHD患者肾性贫血患病率。

Objective To analyze the risk factors of renal anemia in patients with long-term maintenance hemodialysis (MHD). Methods MHD patients who were treated in the hospital from January 2016 to December 2017 were selected for the study according to the inclusion and exclusion criteria. The clinical data, dialysis status and laboratory parameters were collected by referring to the clinical cases and follow-up data. The prevalence rate of renal anemia was counted and taken as a grouping condition, and the univariate analysis was performed first, and then the items with differences in univariate analysis were included in multivariate Logistic regression analysis to determine the independent influencing factors of renal anemia in patients with long-term MHD. Results The prevalence rate of renal anemia was 78.65% in 227 patients with MHD. According to whether there was renal anemia, 174 cases were includedthe in renal anemia group, and the remaining 53 cases with Hb≥110 g/L were included in the control group. Univariate analysis showed that there were statistically significant differences between the two groups in terms of body mass index(BMI),red blood cell count(RBC),albumin,blood calcium,white blood cell count(WBC), hematocrit(Hct),platelet count(PLT),serum ferritin(SF),serum iron(SI),iron saturation ISAT),total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), single pool Kt/V (spKt/V), hepcidin, C-reactive protein (CRP), parathyroid hormone (iPTH), folic acid, uric acid (UA) and serum creatinine (Scr)(P < 0.05). Renal anemia was taken as a dependent variable (yes = 1, no= 0), and the items with differences in univariate analysis were included in multivariate Logistic regression model, and the results showed that ISAT, TIBC, UIBC, spKt/V, hepcidin, CRP and iPTH were independent influencing factors of renal anemia in MHD patients. Conclusion The prevalence rate of renal anemia is high in patients with MHD. It is necessary to pay attention to the above-mentioned influencing factors in clinical practice and actively respond to minimize the prevalence rate of renal anemia in patients with MHD.