贫血和高同型半胱氨酸血症对血液透析患者死亡率的影响

Effect of Anemia and Hyperhomocysteinemia on Mortality ofPatients on Hemodialysis

目的:评估血红蛋白和同型半胱氨酸水平和血透患者死亡率的关系。方法:连续收集维持性血透患者50例,另选取30例无肾功能损害的体检者为对照组。检测血红蛋白、血清铁、血清铁蛋白、转铁蛋白饱和度和同型半胱氨酸等水平。随访1年,确定死亡率并评估其与贫血及同型半胱氨酸血症的关系。结果:43例(86%)患者伴有贫血(血红蛋白<11 g/dl),血清铁蛋白在33例患者中(66%)升高(>500 ng/ml)。1年死亡率为28%(33%贫血患者死亡,而血红蛋白水平>11 g/dl的患者中无人死亡),血红蛋白水平每下降1 g/dl,相对死亡风险增加1.58。所有的患者都伴有高同型半胱氨酸血症,并且同型半胱氨酸水平在血透组及对照组之间差异有统计学意义(P<0.01)。高同型半胱氨酸血症并不影响死亡率,在多元回归分析中,只有血红蛋白水平与死亡率相关。结论:几乎所有的血液透析患者都伴有贫血,而贫血是死亡率的一个危险因素,然而,在一半以上的患者中铁储存量都是足够的,贫血的原因可能是促红细胞生成素缺乏。多数患者都伴有高同型半胱氨酸血症,但它没有独立影响死亡率。

Objective To assess the relationship of hemoglobin and homocysteine levels and mortality of patients on hemodialysis.Method 50 maintenance hemodialysis patients were consecutively collected,30 normal person as control group.Blood samples were drawn for measurement of hematological parameters,serum iron,serum ferritin,transferrin saturation,and homocysteine levels.The patients were followed up for 1 year to determine the mortality rate and evaluate its association with anemia and hyperhomocysteinemia.Results 43 patients(86%)were anemic(hemoglobin<11 g/dl).Serum ferritin was high(>500 ng/ml)in 33 patients(66%).Mortality was 28%in 1 year(33%in anemic patients versus no death among patients with a hemoglobin level greater than 11 g/dl).The relative risk of mortality was increased by 1.58 with every 1 g/dl decrease in hemoglobin level.All of the patients had a high homocysteine level,and a significant difference was observed between the homocysteine levels of the patients on hemodialysis and the control group(P<0.01).Hyperhomocysteinemia did not affect mortality.In multivariate Cox regression analysis,only hemoglobin level was associated with mortality.Conclusion Almost all of our patients on hemodialysis were anemic and this condition was a risk factor of mortality.Iron stores,however,were adequate in more than half of the patients.The reason of anemia could be untreated erythropoietin deficiency.Hyperhomocysteinemia was present in the majority of the patients,but it did not independently affect mortality.