单中心维持性腹膜透析患者肾性贫血现况及相关因素分析

doi:10.3969/j.issn.1004-583X.2022.12.006

摘要/Abstract

摘要：

目的评估维持性腹膜透析患者肾性贫血情况,并对影响腹膜透析患者血红蛋白的各种因素进行分析,指导临床进行干预治疗。方法回顾性分析山东省临沂市人民医院2011年1月-2020年12月在腹膜透析中心规律随访的238例腹膜透析患者的人口学特征及临床资料,以血红蛋白(hematocrystallin,Hb)≥110 g/L为界线,分为Hb合格组(Hb≥110 g/L)和非合格组(Hb<110 g/L),比较2组性别、年龄、基础疾病、生化检查、尿素清除指数(KT/V)、腹膜平衡试验结果等因素,并分析该中心腹膜透析患者血红蛋白治疗合格率及影响因素。结果 ①入组的所有患者的平均Hb水平(103.85±19.13) g/L,合格组108例(45.38%),非合格组130例(54.62%);②单因素分析示Hb水平与总KT/V(r=0.282,P<0.05)、腹膜KT/V(r=0.230,P<0.05)、超滤量(r=0.146,P<0.05)呈正相关 ;与体重指数(r=0.154,P<0.05) 呈负相关。③多因素logistic回归分析表明,BMI、低白蛋白、肌酐高、超滤量是持续不卧床腹膜透析(continu‐ous ambulatory peritoneal dialysis, CAPD)患者Hb不达标的危险因素。结论 BMI、白蛋白、肌酐、超滤量可能是腹膜透析患者Hb治疗合格的预测因素。对于BMI较低、超滤量、腹膜KT/V及总KT/V较好的腹膜透析患者Hb更容易合格。

关键词: 腹膜透析, 贫血, 合格率, 影响因素

Abstract:

Objective To evaluate renal anemia in patients with maintenance peritoneal dialysis, analyze factors affecting hemoglobin in patients with maintenance peritoneal dialysis, and guide clinical intervention and treatment. Methods The demographic characteristics and clinical data of 238 patients with peritoneal dialysis who were regularly followed up in the Peritoneal Dialysis Center of Linyi People's Hospital of Shandong Province from January 2011 to December 2020 were retrospectively analyzed. Hematocrystalin (Hb)≥110 g/L was used as the cutoff value. They were divided into the qualified Hb group (Hb≥110 g/L) and the unqualified Hb group (Hb<110 g/L). Both groups were compared in terms of gender, age, basic disease, biochemical examination, urea clearance index (KT/V), peritoneal balance test results, and other factors. In this center, the qualified rate of hemoglobin treatment and its influencing factors in patients undergoing peritoneal dialysis were analyzed. Results ①The mean Hb of recruited patients was (103.85±19.13) g/L. There were 108 cases (45.38%) in the qualified Hb group and 130 cases (54.62%) in the unqualified Hb group. ② Univariate analysis showed that the Hb level was positively related to total KT/V (r=0.282, P<0.05), peritoneal KT/V (r=0.230, P<0.05) and ultra-filtration amount (r=0.146, P<0.05), which was negatively correlated with body mass index (r=0.154, P<0.05). ③ Multivariate logistic regression analysis showed that body mass index (BMI), low albumin, creatinine, and ultrafiltration volume were risk factors for Hb in patients with continuous ambulatory peritoneal dialysis (CAPD). Conclusion A patient's BMI, albumin, creatinine, and ultrafiltration volume may be used to predict eligibility for Hb therapy during peritoneal dialysis. It is more likely that Hb would qualify for peritoneal dialysis patients with a lower BMI, a higher ultra-filtration volume, and a higher peritoneal KT/V and total KT/V.

Key words: peritoneal dialysis, anemia, percent of pass, factors affecting

中图分类号:

R459.5

张宏涛, 王志奎. 单中心维持性腹膜透析患者肾性贫血现况及相关因素分析[J]. 临床荟萃, 2022, 37(12): 1099-1103.

Zhang Hongtao, Wang Zhikui. Renal anemia in patients with maintenance peritoneal dialysis and Related Factors: A single-center study[J]. Clinical Focus, 2022, 37(12): 1099-1103.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.12.006

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I12/1099

图/表 3

表1 两组基线特征比较

项目	治疗合格组( $n$ =108)	治疗非合格组( $n$ =130)	统计值	P值
透析年龄(月)	21.23±11.59	20.62±13.89	t=0.367	0.714
收缩压(mmHg)	144.56±21.12	143.77±24.20	t=0.271	0.787
BMI(kg/m²)	23.42±2.99	24.42±3.36	t=-2.389	0.018
血小板(×10⁹/L)	220.00±70.36	220.13±84.09	t=-0.013	0.99
红细胞分布宽度(fL)	44.90±5.39	44.90±6.27	t=0.002	0.998
白蛋白(g/L)	36.39±7.12	34.73±6.61	t=1.861	0.064
非结合胆红素(μmol/L)	5.13±2.85	4.63±2.42	t=1.470	0.143
碱性磷酸酶(U/L)	89.30±50.03	85.76±48.37	t=0.551	0.582
前白蛋白(mg/L)	30.68±8.72	32.01±9.97	t=-0.790	0.431
尿素(mmol/L)	23.44±7.00	25.25±7.60	t=-1.884	0.061
尿酸(μmol/L)	396.38±98.40	404.54±115.71	t=-0.58	0.563
总胆固醇(mmol/L)	4.93±1.34	4.68±1.39	t=1.41	0.16
低密度脂蛋白胆固醇(mmol/L)	3.07±1.04	2.92±1.01	t=1.09	0.277
血钾(mmol/L)	4.37±0.82	4.37±0.69	t=0.092	0.927
二氧化碳(mmol/L)	23.87±4.22	23.81±4.02	t=0.122	0.903
血磷(mmol/L)	1.77±0.61	1.89±0.52	t=-1.619	0.107
血清铁(μmol/L)	11.57±5.79	12.85±8.57	t=-0.879	0.382
不饱和铁结合力(μmol/L)	32.78±11.05	34.16±9.85	t=-0.660	0.511
总铁结合力(μmol/L)	44.15±10.46	47.01±9.97	t=-1.407	0.162
4 h D/P	0.68±0.13	0.68±0.14	t=0.087	0.931
超滤量(ml)	261.71±182.06	314.49±176.55	t=-2.264	0.024
总KT/V	2.18±0.79	1.77±0.58	t=2.558	0.013
残肾KT/V	0.61±0.63	0.42±0.49	t=1.468	0.146
腹膜KT/V	1.59±0.60	1.33±0.49	t=2.065	0.042
总Ccr(ml/min)	66.80±27.14	62.96±17.67	t=0.734	0.465
残肾Ccr(ml/min)	28.65±32.38	19.45±19.95	t=1.510	0.136
腹膜Ccr(ml/min)	38.01±16.34	42.75±16.94	t=-1.25	0.215
中性粒细胞(×10⁹/L)	4.595(3.5, 6.4)	4.530(3.6, 6.3)	$Z$ =-0.08	0.936
淋巴细胞(×10⁹/L)	1.190(0.8, 1.5)	1.325(0.9, 1.7)	$Z$ =-2.511	0.012
结合胆红素(μmol/L)	2.000(1.4, 2.7)	1.700(1.3, 2.4)	$Z$ =-1.924	0.054
天冬氨酸氨基转移酶(U/L)	16.300(11.8, 21.1)	15.100(11.7, 21.3)	$Z$ =-0.462	0.644
丙氨酸氨基转移酶(U/L)	12.000(8.4, 17.8)	11.100(7.2, 18.1)	$Z$ =-0.912	0.362
肌酐(μmol/L)	731.500(591.8, 879.8)	841.750(664.5, 1011.8)	$Z$ =-2.633	0.008
空腹血糖(mmol/L)	5.585(5.0, 6.6)	5.350(4.8, 7.1)	$Z$ =-0.364	0.716
甘油三酯(mmol/L)	1.335(0.9, 1.9)	1.170(0.8, 1.6)	$Z$ =-1.701	0.089
高密度脂蛋白胆固醇(mmol/L)	1.140(0.8, 1.4)	1.200(0.9, 1.5)	$Z$ =-1.19	0.234
血钙(mmol/L)	2.230(2.1, 2.4)	2.120(1.9, 2.3)	$Z$ =-2.355	0.019
血钠(mmol/L)	139.350(137.0, 141.1)	139.700(137.3, 141.6)	$Z$ =-1.257	0.209
B₁₂(μg)	517.000(370.5, 665.8)	496.900(370.0, 734.0)	$Z$ =-0.136	0.892
铁蛋白(μg/L)	170.500(77.4, 405.3)	204.000(68.3, 441.6)	$Z$ =-0.131	0.896
叶酸(ng/ml)	6.985(4.3, 14.8)	6.810(3.8, 19.9)	$Z$ =-0.072	0.943
转铁蛋白饱和度(%)	24.000(17.5, 31.1)	24.050(15.4, 39.3)	$Z$ =-0.126	0.900
甲状旁腺素(ng/L)	192.800(93.7, 385.0)	253.900(133.6, 480.9)	$Z$ =-1.857	0.063

表1 两组基线特征比较

项目	治疗合格组( $n$ =108)	治疗非合格组( $n$ =130)	统计值	P值
透析年龄(月)	21.23±11.59	20.62±13.89	t=0.367	0.714
收缩压(mmHg)	144.56±21.12	143.77±24.20	t=0.271	0.787
BMI(kg/m²)	23.42±2.99	24.42±3.36	t=-2.389	0.018
血小板(×10⁹/L)	220.00±70.36	220.13±84.09	t=-0.013	0.99
红细胞分布宽度(fL)	44.90±5.39	44.90±6.27	t=0.002	0.998
白蛋白(g/L)	36.39±7.12	34.73±6.61	t=1.861	0.064
非结合胆红素(μmol/L)	5.13±2.85	4.63±2.42	t=1.470	0.143
碱性磷酸酶(U/L)	89.30±50.03	85.76±48.37	t=0.551	0.582
前白蛋白(mg/L)	30.68±8.72	32.01±9.97	t=-0.790	0.431
尿素(mmol/L)	23.44±7.00	25.25±7.60	t=-1.884	0.061
尿酸(μmol/L)	396.38±98.40	404.54±115.71	t=-0.58	0.563
总胆固醇(mmol/L)	4.93±1.34	4.68±1.39	t=1.41	0.16
低密度脂蛋白胆固醇(mmol/L)	3.07±1.04	2.92±1.01	t=1.09	0.277
血钾(mmol/L)	4.37±0.82	4.37±0.69	t=0.092	0.927
二氧化碳(mmol/L)	23.87±4.22	23.81±4.02	t=0.122	0.903
血磷(mmol/L)	1.77±0.61	1.89±0.52	t=-1.619	0.107
血清铁(μmol/L)	11.57±5.79	12.85±8.57	t=-0.879	0.382
不饱和铁结合力(μmol/L)	32.78±11.05	34.16±9.85	t=-0.660	0.511
总铁结合力(μmol/L)	44.15±10.46	47.01±9.97	t=-1.407	0.162
4 h D/P	0.68±0.13	0.68±0.14	t=0.087	0.931
超滤量(ml)	261.71±182.06	314.49±176.55	t=-2.264	0.024
总KT/V	2.18±0.79	1.77±0.58	t=2.558	0.013
残肾KT/V	0.61±0.63	0.42±0.49	t=1.468	0.146
腹膜KT/V	1.59±0.60	1.33±0.49	t=2.065	0.042
总Ccr(ml/min)	66.80±27.14	62.96±17.67	t=0.734	0.465
残肾Ccr(ml/min)	28.65±32.38	19.45±19.95	t=1.510	0.136
腹膜Ccr(ml/min)	38.01±16.34	42.75±16.94	t=-1.25	0.215
中性粒细胞(×10⁹/L)	4.595(3.5, 6.4)	4.530(3.6, 6.3)	$Z$ =-0.08	0.936
淋巴细胞(×10⁹/L)	1.190(0.8, 1.5)	1.325(0.9, 1.7)	$Z$ =-2.511	0.012
结合胆红素(μmol/L)	2.000(1.4, 2.7)	1.700(1.3, 2.4)	$Z$ =-1.924	0.054
天冬氨酸氨基转移酶(U/L)	16.300(11.8, 21.1)	15.100(11.7, 21.3)	$Z$ =-0.462	0.644
丙氨酸氨基转移酶(U/L)	12.000(8.4, 17.8)	11.100(7.2, 18.1)	$Z$ =-0.912	0.362
肌酐(μmol/L)	731.500(591.8, 879.8)	841.750(664.5, 1011.8)	$Z$ =-2.633	0.008
空腹血糖(mmol/L)	5.585(5.0, 6.6)	5.350(4.8, 7.1)	$Z$ =-0.364	0.716
甘油三酯(mmol/L)	1.335(0.9, 1.9)	1.170(0.8, 1.6)	$Z$ =-1.701	0.089
高密度脂蛋白胆固醇(mmol/L)	1.140(0.8, 1.4)	1.200(0.9, 1.5)	$Z$ =-1.19	0.234
血钙(mmol/L)	2.230(2.1, 2.4)	2.120(1.9, 2.3)	$Z$ =-2.355	0.019
血钠(mmol/L)	139.350(137.0, 141.1)	139.700(137.3, 141.6)	$Z$ =-1.257	0.209
B₁₂(μg)	517.000(370.5, 665.8)	496.900(370.0, 734.0)	$Z$ =-0.136	0.892
铁蛋白(μg/L)	170.500(77.4, 405.3)	204.000(68.3, 441.6)	$Z$ =-0.131	0.896
叶酸(ng/ml)	6.985(4.3, 14.8)	6.810(3.8, 19.9)	$Z$ =-0.072	0.943
转铁蛋白饱和度(%)	24.000(17.5, 31.1)	24.050(15.4, 39.3)	$Z$ =-0.126	0.900
甲状旁腺素(ng/L)	192.800(93.7, 385.0)	253.900(133.6, 480.9)	$Z$ =-1.857	0.063

表2 PD患者Hb相关性分析

项目	r值	P值
BMI	-0.154	0.018
淋巴细胞	-0.089	0.171
白蛋白	0.12	0.064
肌酐	-0.125	0.049
钙离子	0.079	0.224
超滤量	0.146	0.024
总KT/V	0.282	0.013
腹膜KT/V	0.230	0.042

表3 PD患者贫血多因素logistic 回归分析结果

变量	回归系数	标准误	$Z$ 值	Wald χ²值	P值	$O R$ 值	95%CI
变量	回归系数	标准误	$Z$ 值	Wald χ²值	P值	$O R$ 值	下限	上限
BMI	-0.097	0.044	2.173	4.722	0.03	1.101	1.010	1.202
白蛋白	0.041	0.021	-1.997	3.99	0.046	0.96	0.922	0.999
肌酐	-0.001	0	2.383	5.678	0.017	1.001	1.000	1.002
超滤量	0.002	0.001	2.165	4.687	0.03	1.002	1.000	1.003

表3 PD患者贫血多因素logistic 回归分析结果

变量	回归系数	标准误	$Z$ 值	Wald χ²值	P值	$O R$ 值	95%CI
变量	回归系数	标准误	$Z$ 值	Wald χ²值	P值	$O R$ 值	下限	上限
BMI	-0.097	0.044	2.173	4.722	0.03	1.101	1.010	1.202
白蛋白	0.041	0.021	-1.997	3.99	0.046	0.96	0.922	0.999
肌酐	-0.001	0	2.383	5.678	0.017	1.001	1.000	1.002
超滤量	0.002	0.001	2.165	4.687	0.03	1.002	1.000	1.003

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