CAJ | 학술논문

目的探讨新乡地区接受维持性血液透析的糖尿病患者与非糖尿病患者贫血现况及相关影响因素.方法纳入2012年1月至2012年3月在新乡市第一人民医院、新乡市中心医院、河南宏力医院和辉县市人民医院接受维持性血液透析治疗3个月或以上的患者364例,其中男209例,女155例,年龄20～ 93岁,平均(52±l5)岁.将其分为糖尿病组[n=98,其中男44例,女54例,年龄23 ～ 85岁,平均(60±12)岁]和非糖尿病组[n=266,其中男165例,女101例,年龄20 ～ 93岁,平均(48±17)岁],分析两组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、甲状旁腺素的关系.采用t检验、x2检验和方差分析进行数据统计.结果与非糖尿病组比较,糖尿病组患者贫血发生率显著升高(78.6％ vs 67.3％,P＜0.05),血红蛋白水平及血红蛋白达标率显著降低[(90±19) vs(96±23) g/L,21.4％ vs 32.7％；均P＜0.05].糖尿病组血白蛋白、前白蛋白、透析龄、甲状旁腺素水平明显低于非糖尿病组[(37±6)vs(39±5)g/L,(483±143) vs(586±138) mg/L,(23±22) vs(34±26)个月,(77±132) vs(155±240)pmol/L;均P＜0.01],透析频率明显高于非糖尿病组[(9.9±1.8) vs(9.1±2.1)h/w,P＜0.01],C反应蛋白及血钙水平明显高于非糖尿病组水平[(8±14)vs(3±10)mg/L,(2.0±0.4)vs(1.9±0.3) mmol/L;均P＜0.05].促红细胞生成素治疗量、铁剂治疗率、铁指标达标率两组差异无统计学意义(均P＞0.05).结论在使用相同剂量的促红细胞生成素的情况下,接受维持性血液透析的糖尿病患者贫血发生率高,血红蛋白达标率低,贫血可能与炎症、营养不良有关,提示在给予充足的促红细胞生成素和铁剂治疗的同时,应加强患者营养治疗.
목적 탐토신향지구접수유지성혈액투석적당뇨병환자여비당뇨병환자빈혈현황급상관영향인소.방법 납입2012년1월지2012년3월재신향시제일인민의원、신향시중심의원、하남굉력의원화휘현시인민의원접수유지성혈액투석치료3개월혹이상적환자364례,기중남209례,녀155례,년령20～ 93세,평균(52±l5)세.장기분위당뇨병조[n=98,기중남44례,녀54례,년령23 ～ 85세,평균(60±12)세]화비당뇨병조[n=266,기중남165례,녀101례,년령20 ～ 93세,평균(48±17)세],분석량조환자빈혈현황급기여촉홍세포생성소、철제、영양불량、투석충분성、미염증、갑상방선소적관계.채용t검험、x2검험화방차분석진행수거통계.결과 여비당뇨병조비교,당뇨병조환자빈혈발생솔현저승고(78.6％ vs 67.3％,P＜0.05),혈홍단백수평급혈홍단백체표솔현저강저[(90±19) vs(96±23) g/L,21.4％ vs 32.7％；균P＜0.05].당뇨병조혈백단백、전백단백、투석령、갑상방선소수평명현저우비당뇨병조[(37±6)vs(39±5)g/L,(483±143) vs(586±138) mg/L,(23±22) vs(34±26)개월,(77±132) vs(155±240)pmol/L;균P＜0.01],투석빈솔명현고우비당뇨병조[(9.9±1.8) vs(9.1±2.1)h/w,P＜0.01],C반응단백급혈개수평명현고우비당뇨병조수평[(8±14)vs(3±10)mg/L,(2.0±0.4)vs(1.9±0.3) mmol/L;균P＜0.05].촉홍세포생성소치료량、철제치료솔、철지표체표솔량조차이무통계학의의(균P＞0.05).결론 재사용상동제량적촉홍세포생성소적정황하,접수유지성혈액투석적당뇨병환자빈혈발생솔고,혈홍단백체표솔저,빈혈가능여염증、영양불량유관,제시재급여충족적촉홍세포생성소화철제치료적동시,응가강환자영양치료.
Objective To investigate present situation and related factors of anemia in patients with diabetic nephropathy who received maintenance hemedialysis (MHD).Methods A total of 364 patients who underwent MHD in four hospitals of Henan Province were enrolled and assigned to the diabetes group (n =98,male 44,female 54,mean age (60± 12) years old) and the non-diabetes group (n =266,male 165,female 101,mean age (48 ± 17) years old).Relationship between hemoglobin levels with erythropoietin(EPO),iron,malnutrition,adequacy of dialysis,inflammation and parathyroid hormone (PTH) was analyzedin all the participants.Student' s t test or Chi-square test was used for data analysis.Results Incidence of anemia was higher in the diabetes group than the non-diabetes group (78.6％ vs 67.3％,P＜0.05).The level of serum hemoglobin and the rote of hemoglobin target were significantly decreased in the diabetes group ((90 ± 19) vs(96 ± 23) g/L,21.4％ vs 32.7％; both P ＜ 0.05).The level of serum albumin,prealbumin,dialysis age and PTH were significantly lower,and the level of dialysis frequency wassignificantly higher in the diabetes group than the non-diabetes group ((37 ± 6) vs (39 ± 5) g/L,(483 ±143) vs (586 ± 138) mg/L,(23 ± 22) vs (34 ± 26) months,(77 ± 132) vs (155 ± 240) pmol/L; all P ＜0.01).Serum levels of CRP and calcium in the diabetes group were significantly higher than those in the non-diabetes group ((8± 14) vs (3± 10) mg/L,(2.0±0.4) vs (1.9±0.3) tmol/L; both P＜0.05).There were no significant differences in EPO dose,treatment rate and standard rate of iron between the two groups (all P＞0.05).Conclusion In the case of using the same dose of EPO,the incidence ofanemiais high and the rate of hemoglobin target is low in MHD patients with diabetes,which is associated with inflammation and malnutrition.It is important to treat anemic MHD patients with enough EPO and iron,in the meantime,more attention must be put to the treatment of malnutrition and inflammation.