目的 对玉树州血液透析中心维持性血液透析(maintenance hemodialysis,MHD)患者进行横断面调查，了解该地区透析患者的人口学特征、原发病情况及肾性贫血控制情况。 方法 选取玉树州3家透析中心(玉树州人民医院、玉树市人民医院、囊谦县医院)2024年1月1日—6月30日规律血液透析的患者作为研究对象，通过查阅病历及问卷调查，收集患者一般资料、原发病、合并症/并发症情况，记录患者实验室检查结果，分析患者的临床特征。根据血红蛋白(hemoglobin，Hb)情况将患者分为Hb达标组及未达标组，对比2组患者临床特征及实验室检查结果，并分析影响Hb达标的相关危险因素。 结果 共纳入70例透析患者，平均年龄(54.54±13.60)岁，男性52例(74.29%)，藏族69例(98.57%)，患者平均就医半径156.7 km，初中及以下文化程度占85.71%。原发病以原发性肾小球肾炎(30.0%)、糖尿病肾病(22.9%)常见。Hb控制率52.9%，Hb平均水平(110.21±24.21)g/L。Hb不达标组与达标组相比，血白蛋白(albumin，ALB)较低(t=-2.924，P=0.003)，低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)较高(t=-3.497,P=0.001)。多因素Logistic回归分析显示：在校正其他混杂因素后，ALB为保护因素，其水平升高可降低Hb不达标风险(OR=0.851，95%CI：0.745～0.973，P=0.018)；LDL-C为危险因素，其水平升高可增加Hb不达标风险(OR=3.386，95%CI：1.332～8.607，P=0.010)。 结论 玉树藏族自治州MHD患者临床特点与平原地区MHD患者存在差异，ALB为Hb达标的保护因素、LDL-C为危险因素，临床可针对上述影响因素制定个体化治疗方案，以改善患者贫血状况。后续可进一步开展研究，探讨该地区MHD患者临床特点与平原地区存在差异的具体原因。
Abstract
Objective To conduct a cross-sectional survey on maintenance hemodialysis (MHD) patients in the Yushu Prefecture Hemodialysis Center, and to investigate the demographic characteristics, primary diseases, and control status of renal anemia in dialysis patients in this region. Methods Patients receiving regular hemodialysis from January 1 to June 30, 2024, in 3 hemodialysis centers in Yushu Prefecture were selected as the research subjects. General patient information, primary diseases, comorbidities/complications were collected by reviewing medical records and conducting questionnaires. Laboratory test results of the patients were recorded to analyze their clinical characteristics. Patients were divided into a hemoglobin (Hb)-target-achieving group and a Hb-non-target-achieving group based on Hb levels. Differences in clinical characteristics and laboratory test results between the two groups were compared, and risk factors affecting Hb target achievement were analyzed. Results A total of 70 dialysis patients were included, with a mean age of (54.54±13.60) years. Among them, 52 were male (74.29%) and 69 were Tibetan (98.57%). The average medical treatment radius of the patients was 156.7 kilometers, and 85.71% had an education level of junior high school or below. Primary diseases were mainly primary glomerulonephritis(30.0%) and diabetic nephropathy(22.9%). The control rate of hemoglobin (Hb) reaches 52.9%,the average Hb level was (110.21±24.21) g/L.Compared with the hemoglobin (Hb)-target-achieving group, the Hb-non-target-achieving group had significantly lower serum albumin (ALB) levels (t=-2.924, p=0.003) and significantly higher low-density lipoprotein cholesterol (LDL-C) levels (t=-3.497, p=0.001).Multivariate Logistic regression analysis showed that after adjusting for other confounding factors, ALB was a protective factor, and its increased level could reduce the risk of Hb inadequacy (OR=0.851, 95%CI 0.745～0.973, P=0.018); LDL-C was a risk factor, and its increased level could increase the risk of Hb inadequacy (OR=3.386, 95%CI 1.332～8.607, P=0.010). Conclusion The clinical characteristics of maintenance hemodialysis (MHD) patients in Yushu Tibetan Autonomous Prefecture are different from those in plain areas. Their Hb compliance rate is affected by the levels of ALB and LDL-C, among which ALB is a protective factor and LDL-C is a risk factor. Clinically, individualized treatment plans can be formulated for the above influencing factors to improve the anemia status of patients. In the future, further studies can be carried out to explore the specific reasons for the differences in clinical characteristics between MHD patients in this area and those in plain areas.
关键词
玉树 /
维持性血液透析 /
慢性肾脏病 /
肾性贫血 /
高原地区
Key words
Yushu /
Hemodialysis /
Chronic kidney disease /
Renal anemia /
High-altitude region
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