腹膜透析患者贫血情况及危险因素分析

Anemia situation and risk factors analysis in patients with peritoneal dialysis

目的探讨腹膜透析(PD)患者血红蛋白水平及贫血相关危险因素。方法选择2012年1月至2013年1月在四川大学华西医院随访的253例维持性腹膜透析患者的临床资料,根据年龄将患者分为老年组(>65岁)和非老年组(≤65岁),比较分析两组血红蛋白水平、铁代谢指标、营养指标[包括血清清蛋白(ALB)、标准化蛋白分解代谢率(nPCR)]、甲状旁腺激素(PTH)、高敏C反应蛋白(hsCRP)、肾小球i滤过率估值(eGFR)、尿素清除指数(KT/V)等指标差异。结果血红蛋白水平与年龄、铁代谢指标(血清铁和血清铁饱和度)、转铁蛋白、ALB、前清蛋白和eGFR呈正相关,与hsCRP呈负相关;老年组和非老年组铁蛋白水平和血清铁饱和度差异无统计学意义(P>0.05)。与老年组相比,非老年组的营养指标(ALB和nPCR)较好,且hsCRP水平较低,但非老年组血红蛋白低于老年组。结论腹膜透析患者血红蛋白水平和年龄的呈正相关,非老年患者血红蛋白水平差于老年患者。应关注年轻患者的贫血问题,积极寻找原因并制订对策,以提高患者的生活质量。

Objective To analyze the hemoglobin(Hb)level and anemia related risk factors in the patients with peritoneal dialysis.Methods The clinical data of 253 patients with maintenance peritoneal dialysis and follow up in West China Hospital of Sichuan University from January 2012 to January 2013 were collected and the hemoglobin levels were retrospectively analyzed for searching the related factors affecting the Hb level.The patients were divided into the elderly group(>65 years old)and the non-elderly group(≤65 years old).The differences in the indexes were analyzed and compared between the two groups,such as the Hb level,iron metabolism indices,nutritional indicators including serum albumin(ALB),normalized protein catabolic rate(nPCR),parathyroid hormone(PTH),high-sensitivity C-reactive protein(hsCRP),residual renal function(eGFR),and urea clearance index(KT/V).Results The Hb level was positively correlated with the age,iron metabolism indexes(serum iron and serum iron saturation),transferring,ALB,prealbumin and eGFR,and negatively correlated with hsCRP.There was no statistically significant difference in the ferritin level and serum iron saturation between the elderly group and non-elderly group(P>0.05).Compared with the elderly group,the nutritional indicators(albumin and nPCR)of the non-elderly group were better,moreover the hsCRP level was lower,but the Hb level of the non-elderly group was lower than that of the elderly group.Conclusion The Hb level of the patients with peritoneal dialysis is positively correlated with the age,and the Hb level of the non-elderly patients is worse than that of the elderly patients.Should pay attention to the anemia problem in young patients,actively seek the causes and formulate the countermeasures to improve the quality of life of the patients.