维持性血液透析患者贫血与铁状态区域性多中心调查研究

Regional multicenter investigation of anemia and iron status in maintenance hemodialysis patients

目的对区域性维持性血液透析患者贫血及铁状态分布特征、药物使用情况进行横断面调查,明确相关指标之间的关系,为制定最佳贫血管理策略提供数据支撑。方法抽取苏皖赣三省12家血液净化中心作为研究单位,纳入2021年9月~2021年12月来自上述单位的维持性血液透析的患者,收集一般人口学资料及透析前实验室检查指标,用相关分析方法描述多中心维持性血液透析患者血红蛋白(Hb)达标情况、贫血及铁状态分布特征,并探讨影响Hb达标的相关因素。结果本研究共纳入符合标准的患者1710例,其中男性1044例,女性666例,平均年龄为(58.3±13.8)岁。总体Hb达标率为47.7%,各分中心Hb分布情况(χ^(2)=157.594,P<0.001)及达标率差异较大(χ^(2)=124.509,P<0.001)。70.1%的患者血清铁蛋白(SF)<200μg/L,1.9%的患者SF超过1000μg/L。64.7%患者转铁蛋白饱和度(TSAT)在20%~49%。TSAT每改变1%,血红蛋白达标的OR值为1.029(95%CI:1.004~1.055,P=0.023)。结论样本单位总体Hb达标率不理想,大部分患者铁储备适度或稍有欠缺,极少数患者存在铁过载。各分中心Hb达标情况及铁状态分布特征差异较大。TSAT是Hb达标的独立保护因素。

Objective This study intended to conduct a cross-sectional survey of anemia and iron status distribution characteristics and drug use in regional maintenance hemodialysis patients to clarify the relationship between relevant indicators and provide data support for the development of optimal anemia management strategies.Methods Twelve blood purification centers in three provinces including Jiangsu Province,Anhui Province and Jiangxi Province were selected.Maintenance hemodialysis patients from September 2021 to December 2021 were included.General demographic data and laboratory parameters before dialysis were collected.Describe hemoglobin(Hb)reaching standards,anemia and iron status distribution characteristics of multicenter maintenance hemodialysis patients,and to explore the related factors affecting the control rate of Hb.Results A total of 1710 patients who met the criteria were included in this study,including 1044 males and666 females,with a mean age of 58.3±13.8 years.The overall standard rate of Hb was 47.7%,and the Hb distribution(χ~2=157.594,P<0.001)and standard rate(χ~2=124.509,P<0.001)were significantly different among the sub-centers.The majority of patients(70.1%)had serum ferritin(SF)<200μg/L and 1.9%had SF more than 1000μg/L.The transferrin saturation(TSAT)of 64.7%patients was between 20%and 49%.For every1%change in TSAT,the OR of Hb reaching target was 1.029(P=0.023,95%CI:1.004~1.055).Conclusion The overall standard rate of Hb of sample units was not satisfactory.Most patients had moderate or slight iron reserve,and very few patients had iron overload.There were significant differences in Hb and iron status distribution characteristics among sub-centers.TSAT was an independent protective factor to achieve the target of Hb.