维持性血液透析患者肾性贫血的多因素分析及相关性研究

吕晴; 陈卫东; 刘磊

doi:10.16766/j.cnki.issn.1674-4152.001938

维持性血液透析患者肾性贫血的多因素分析及相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.001938

蚌埠医学院第一附属医院肾病科，安徽蚌埠 233004

基金项目:

安徽省高等学校自然科学研究项目 KJ2019A0321

详细信息

通讯作者:
陈卫东, E-mail: cwd2012@163.com

中图分类号: R459.5 R692
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出版历程
- 收稿日期: 2020-10-21
- 网络出版日期: 2022-02-16

Multivariate analysis and correlation study of anaemia in patients with maintenance haemodialysis

Department of Nephrology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨维持性血液透析(maintenance hemodialysis，MHD)患者发生贫血的多种病因及其相关性。方法通过横断面调查2019年10月—2020年6月蚌埠市区内3个血液净化中心304例MHD患者的人口学资料、透析治疗信息、实验室指标等，根据2012年改善全球肾脏病预后组织(KDIGO)指南建议MHD患者的目标血红蛋白水平将收集的304例MHD患者分为贫血组(177例)与非贫血组(127例)，采用单因素分析对患者贫血的危险因素进行分析，后将差异有统计学意义的因素纳入logistic多因素分析，分析影响MHD患者贫血的危险因素。结果入组的304例MHD患者平均年龄(55.30±13.13)岁，平均透析龄48(32, 84)个月，其中贫血的患病率为58.2%，贫血组中高血压患病率、铁蛋白、甲状旁腺激素(PTH)均高于非贫血组(均P < 0.05), 白蛋白、Ca²⁺、及α-骨化醇的人数比例明显低于非贫血组(均P < 0.05)。将差异有统计学意义的因素纳入logistic多因素分析显示，高血压、较高水平的铁蛋白是MHD患者贫血的独立危险因素，而服用α骨化醇、Alb是其保护因素。结论高血压、较高水平的铁蛋白是MHD患者贫血的独立危险因素，而患者的营养状况及α骨化醇的应用是贫血的保护因素，临床应重视上述影响因素，积极应对，最大限度降低MHD患者肾性贫血患病率，进一步提高MHD患者的生活质量。
- 维持性血液透析 /
- 肾性贫血 /
- 多因素研究 /
- 相关性分析
Abstract: Objective To investigate the multiple aetiologies and correlation of anaemia in patients with maintenance haemodialysis (MHD). Methods A cross-sectional investigation was used to analyse the demographic data, dialysis treatment information and laboratory indicators of patients with MHD in three blood purification Centers of Bengbu from October 2019 to June 2020. According to the target haemoglobin level recommended by Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 2012, 304 patients with MHD were divided into anaemia group and non-anaemia group. Single factor was first used to carry out the analysis for two groups. The single factor with statistical significance was then included in the logistic multiple-factor analysis so as to analyse the risk factors of anaemia in patients with MHD. Results The average age of the 304 patients with MHD was (55.30±13.13) years, the average dialysis age was 48 (32, 84) months, and the prevalence of anaemia was 58.2%. The prevalence of hypertension, ferritin and parathyroid hormone (PTH) in anemia group were higher than those in non-anemia group (all P < 0.05), and albumin, Ca²⁺, and the number of people taking α-calcidol were significantly lower than those in non-anemia group (all P < 0.05). Logistic multiple-factor analysis of single factor with statistical significance showed that hypertension and ferritin were the independent risk factors of anaemia in patients with MHD, whereas α-calciferol and Alb taken were the protective factors. Conclusion The condition of hypertension and high level of ferritin are the independent risk factors of anaemia in patients with MHD, whereas the nutritional status of patients and application of α-calciferol are the protective factors. Therefore, the above influencing factors should be given attention. They should be actively dealt with to reduce the incidence of renal anaemia in patients with MHD and further improve their quality of life.
- Maintenance haemodialysis /
- Renal anaemia /
- Multiple-factor study /
- Correlation analysis

HTML全文

表 1 MHD患者贫血的单因素分析[M(P₂₅, P₇₅)]

项目	类别	贫血组(177例)	非贫血组(127例)	统计量	P值
高血压[例(%)]		156(88.14)	99(77.95)	5.671^a	0.017
叶酸[例(%)]		26(14.70)	29(22.83)	3.311^a	0.069
α骨化醇[例(%)]		115(64.97)	98(77.17)	5.242^a	0.022
实验室指标	白蛋白(g/L)	41.64(39.60，43.20)	43.56(41.19，45.76)	-2.421^b	0.015
	Ca²⁺(mmol/L)	2.20(2.10, 2.32)	2.23(2.15, 2.37)	-2.045^b	0.041
	PTH(pg/mL)	416.00(233.08, 829.00)	365.50(190.08, 589.93)	2.088^b	0.037
	铁蛋白(μg/L)	320(70.25.963.50)	121.00(31.00, 435.00)	3.779^b	< 0.001
注：^a为χ²值，^b为Z值。

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表 2 MHD患者肾性贫血的logistic多因素回归分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
Alb	-0.189	0.039	22.921	< 0.001	0.828	0.766~0.894
铁蛋白	0.859	2.903	17.998	< 0.001	2.361	1.587~3.511
PTH	-3.662	2.667	1.886	0.170	1.000	0.998~1.000
Ca²⁺	0.512	0.514	0.990	0.320	1.668	0.609~4.571
高血压	0.742	0.316	5.520	0.019	2.101	1.121~3.903
α骨化醇	-0.600	0.264	5.177	0.023	0.549	0.327~0.920

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