CAJ | 학술논문

目的探讨维持性血液透析患者的贫血现况及相关影响因素.方法收集2012年1月至3月新乡地区4家综合医院364例维持性血液透析3个月以上患者的临床资料.分析维持性血液透析患者贫血现况及其与促红细胞生成素、铁剂、营养不良、透析充分性、微炎症、甲状旁腺激素等因素的关系.结果 364例患者中促红细胞生成素治疗率为97％,铁剂治疗率为87％,贫血治疗达标率仅为30％,贫血治疗达标组患者的血白蛋白、转铁蛋白饱和度、透析龄、尿素清除指数、铁蛋白和转铁蛋白饱和度两者均达标率患者非达标组比较差异有统计学意义(P均＜0.05).而贫血治疗达标组患者的血红蛋白、透析频率、铁蛋白值、前白蛋白、铁蛋白和转铁蛋白饱和度达标率与非达标组比较差异有统计学意义(P均＜0.01),C反应蛋白值与非达标组比较差异有统计学意义(P＜0.01).贫血治疗达标组促红细胞生成素治疗量在与未达标组比较差异无统计学意义(P＞0.05),但其用量远低于肾脏病预后质量指南中推荐的量.多因素Logistic回归分析结果显示白蛋白、前白蛋白、尿素清除指数、透析频率是维持性透析贫血的独立影响因素.结论新乡地区大部分维持性血液透析贫血患者均接受促红细胞生成素和铁剂治疗,但治疗仍不充分,达标率较低.营养不良、微炎症、透析不充分、性别也是贫血治疗达标率低的原因,但白蛋白、前白蛋白、尿素清除指数、透析频率是维持性血液透析贫血的独立影响因素.提示我们在采用充足的促红细胞生成素和铁剂治疗维持性血液透析贫血患者的同时,应加强其营养治疗和充分透析的宣传教育.
목적 탐토유지성혈액투석환자적빈혈현황급상관영향인소.방법 수집2012년1월지3월신향지구4가종합의원364례유지성혈액투석3개월이상환자적림상자료.분석유지성혈액투석환자빈혈현황급기여촉홍세포생성소、철제、영양불량、투석충분성、미염증、갑상방선격소등인소적관계.결과 364례환자중촉홍세포생성소치료솔위97％,철제치료솔위87％,빈혈치료체표솔부위30％,빈혈치료체표조환자적혈백단백、전철단백포화도、투석령、뇨소청제지수、철단백화전철단백포화도량자균체표솔환자비체표조비교차이유통계학의의(P균＜0.05).이빈혈치료체표조환자적혈홍단백、투석빈솔、철단백치、전백단백、철단백화전철단백포화도체표솔여비체표조비교차이유통계학의의(P균＜0.01),C반응단백치여비체표조비교차이유통계학의의(P＜0.01).빈혈치료체표조촉홍세포생성소치료량재여미체표조비교차이무통계학의의(P＞0.05),단기용량원저우신장병예후질량지남중추천적량.다인소Logistic회귀분석결과현시백단백、전백단백、뇨소청제지수、투석빈솔시유지성투석빈혈적독립영향인소.결론 신향지구대부분유지성혈액투석빈혈환자균접수촉홍세포생성소화철제치료,단치료잉불충분,체표솔교저.영양불량、미염증、투석불충분、성별야시빈혈치료체표솔저적원인,단백단백、전백단백、뇨소청제지수、투석빈솔시유지성혈액투석빈혈적독립영향인소.제시아문재채용충족적촉홍세포생성소화철제치료유지성혈액투석빈혈환자적동시,응가강기영양치료화충분투석적선전교육.
Objective To investigate the present situation and related factors of anemia in patients with maintenance hemodialysis( MHD).Methods 364 MHD patients clinical data in 4 hospital in Xinxiang district during In January 2012 to March 2012 were enrolled this study,and they received a minimum of 3 months, MHD therapy. We analysed the present situation of anemia in patients with MHD and the relationship between hemoglobin levels with some factors,for example,lerythropoietin (EPO) iron,malnutrition,adequacy of dialysis,inflammation,parathyroid hormone ( PTH ) and so on.Results 97％ and 88％ patients had been treated with EPO and iron respectively,and the up-to-standard of hemoglobin was only 29.7％.In the standard group (Hb≥ 110 g/L),the level of the blood albumin,transferrin saturation,dialysis age,Kt/v,ferritin and transferr in saturation both compliance rate was significantly higher than that of non standard group ( Hb ≤ 110 g/L,all P ＜ 0.05 ),and the level in standard group of hemoglobin,dialysis frequency,ferritin values,prealbumin,ferritin and transferrin saturation rates of reaching the standards was extremely significantly higher than that non standard group (all P ＜ 0.01).There was no significant difference with the treatment dose of EPO between two groups,but the doses of EPOin two groups were lower than the targets for EPO in Kidney Disease Outcomes Quality Initiative (K/DOQI).The logistic regression model showed that albumin,prealbumin,Kt/v,dialysis frequency were independently correlated with the anemia of MHD patients.Conclusions Most of the anemic patients with MHD had been treated with EPO and iron,but there were also a great quantity of patients hadn,t been treated with plenty of EPO and iron,which resulted low rate of Hb target.Malnutrition,inflammation,inadequate dialysis,gender were also the reasons of low rate of Hb target,but albumin,prealbumin,Kt/v and dialysis frequency were independently correlated with the anemia of MHD patients.It is important to treat anemic MHD patients with enough EPO and iron,in the meantime,we must pay more attention to the treatment of malnutrition and the education of patients about adequacy of dialysis.