中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (02): 121-125.doi: 10.3969/j.issn.1671-4091.2017.02.013

• 临床研究 • 上一篇    下一篇

腹膜透析患者血红蛋白达标率及其相关因素分析

李振元1,张贺1,陆晓蓉1,曹励欧1,袁江姿1,俞赞喆1,严豪1,倪兆慧1,钱家麒1,方炜1   

  1. 1上海交通大学医学院附属仁济医院肾脏科上海市腹膜透析研究中心(张贺为共同第一作者)
  • 收稿日期:2016-06-13 修回日期:2016-11-24 出版日期:2017-02-12 发布日期:2017-02-12
  • 通讯作者: 方炜 fangwei_sh@126.com E-mail:fangwei_sh@126.com
  • 基金资助:

    上海交通大学医学院高原高峰之双百人计划“研究型医师”项目(20152211)；上海市科委项目(114119a5900)

Hemoglobin level and its related factors in patients undergoing peritoneal dialysis

  • Received:2016-06-13 Revised:2016-11-24 Online:2017-02-12 Published:2017-02-12

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摘要： 目的探讨不同透析龄腹膜透析患者血红蛋白达标率及其相关因素，为临床治疗腹膜透析患者贫血提供依据。方法入选2000 年1 月至2013 年5 月期间在上海交通大学医学院附属仁济医院开始规律腹膜透析的所有透析龄≥3 个月的资料完整的患者。以血红蛋白100～120g/L 为目标范围评估患者透析各时间点血红蛋白达标率及其相关因素。结果共有521 例患者入选本研究。本组患者透析前的血红蛋白达标率为14.8%，腹膜透析1、6、12、24、36 月的血红蛋白达标率分别为36.3%、40.7%、43.8%、42.1%、42.6%，与透析前相比，腹膜透析后血红蛋白达标率均明显升高(1 月χ2=207.112，P＜0.001；6 月χ2=230.008，P＜0.001；12 月χ2=189.613，P＜0.001；24 月χ2=162.607，P＜0.001；36 月χ2=168.074，P＜0.001)。各时间点血红蛋白≥10g/dL 的比例分别为16.7%、72.2%、73.1%、77.1%、78.9%和78.1%。多因素逐步回归分析显示，血磷(β=-0.104，P=0.023)、血清白蛋白(β=0.167,P＜0.001)、空腹血糖(β=0.110,P =0.016)、转铁蛋白饱和度(β=0.482,P＜0.001)和残肾功能(β=0.127,P=0.006)是腹膜透析1 月时血红蛋白的独立相关因素。腹膜透析36 月时，转铁蛋白饱和度(β=0.494，P＜0.001)和残肾功能(β=0.182，P=0.001)是血红蛋白的独立相关因素。结论腹膜透析患者的血红蛋白达标率较透析前显著增高，但总体达标率仍不理想；转铁蛋白饱和度和残肾功能是影响腹膜透析患者血红蛋白水平的独立因素。

关键词: 腹膜透析, 血红蛋白, 转铁蛋白饱和度, 残肾功能

Abstract: Objective To investigate the hemoglobin level and its related factors in patients on peritoneal dialysis (PD). Methods All patients initiated PD in the period from Jan. 2000 to May 2013 in Renji Hospital, Shanghai Jiao Tong University School of Medicine and continued on PD for ≥3 months with complete data were enrolled in this study. Patients were followed up for at least 36 months or until death, transferred to hemodialysis or other centers, or lost of our follow-up. Percentage of patients with hemoglobin 100-120g/L was calculated at predialysis, PD for 1, 6, 12, 24 and 36 months. Multivariate regression analysis was used to determine the related factors for hemoglobin level. Results A total of 521 patients were enrolled in this study. Among them, 256 (49.1%) were males, the mean age was 54.3±14.8 years, and 110 (21.1%) patients had diabetes mellitus. Before PD, the percentage of patients with hemoglobin 100～120g/L was 14.8%, and the percentage increased to 36.3%, 40.7%, 43.8%, 42.1% and 42.6% on PD for 1, 6, 12, 24 and 36 months respectively (P＜0.001). The percentage of patients having targeted hemoglobin level (100～120g/L) was significantly higher after PD as compared with that of before PD (χ2=207.112, P＜0.001 after one month; χ2=230.008, P＜0.001 after 6 months; χ2=189.613, P＜0.001 after 12 months; χ2=162.607, P＜0.001 after 24 months; χ2=168.074, P＜0.001 after 36 months). Multivariate regression analysis showed that phosphorus (β =-0.104, P= 0.023), serum albumin (β=0.167, P＜0.001), fasting blood glucose (β= 0.110, P=0.016), transferrin saturation (β=0.482, P＜0.001) and residual renal function (β=0.127, P=0.006) were the independent factors relating to hemoglobin level on PD for one month, and that transferrin saturation (β=0.494, P＜0.001) and residual renal function (β =0.482, P＜0.001) were the independently factors relating to hemoglobin level on PD for 36 months. Conclusions PD can significantly cause the increase of hemoglobin level, but the percentage of patients
having targeted hemoglobin level (100～120g/L) was unsatisfactory. Transferrin saturation and residual renal function were the independent factors affecting the hemoglobin level in PD patients.

Key words: Peritoneal dialysis, Hemoglobin, Transferrin saturation, Residual renal function