摘要
目的回顾性分析上海交通大学医学院附属仁济医院血液透析中心维持性血液透析（MHD）患者贫血状况，评价MHD患者贫血状况与预后的关系。方法人选2007年1月1日至2014年12月31日8年期间，本院血液透析中心透析龄≥3个月MHD患者517例，随访患者从入选至患者死亡、终止血液透析、转肾移植、转其他中心、失随访或至研究终止日期的临床及实验室检查资料。人选患者每3个月测定血红蛋白（Hb）、血清铁蛋白（Ferritin）、转铁蛋白饱和度（TSAT）。依据KDOQI指南中血红蛋白、血清铁蛋白、转铁蛋白饱和度靶目标，将患者分为血红蛋白达标组（110≤Hb≤120g／L）与血红蛋白未达标组，分析本中心MHD患者血红蛋白、血清铁蛋白、转铁蛋白饱和度达标率，并分析MIID患者血红蛋白达标的影响因素以及与患者生存的关系。结果患者平均年龄（63．76±14．78）岁，男性310例（59．96％），血红蛋白、转铁蛋白饱和度、铁蛋白达标率分别为35．20％、91．26％和31．18％。血红蛋白达标组平均TSAT及Ferritin与血红蛋白未达标组差异无统计学意义，但血红蛋白达标组TSAT及Ferrtin达标率均显著高于血红蛋白未达标组（94．97％比89．41％，P=0．045；37．22％比28．13％，P=0．036）。多因素Logistic回归分析显示血全段甲状旁腺激素（iPTH）、血清白蛋白、透析龄是影响MHD患者血红蛋白达标的独立危险因素。Kaplan—Meier生存分析显示血红蛋白达标组患者8年生存率与心脑血管生存率显著高于血红蛋白未达标组（86．70％比75．30％，X^2Log rank=7．134，P=0．008；93．80％比85．30％，X^2Log rank=6．134，P=0．013）。透析频率、年龄以及血清铁蛋白是MHD血红蛋白未达标患者全因死亡的独立危险因素，而透析频率是MHD血红蛋白未达标患者心脑血管死亡的独立危险因素。结论MHD患者血红蛋白达标率控制尚不理想。透析龄、血iPTH、血清白蛋白是MHD患者血红蛋白达标的独立危险因素。MHD患者血红蛋白未达标将增加患者全因死亡率及心脑血管死亡率。
Objective To analysis the relationship between anemia and clinic outcomes retrospectively in maintenance hemodialysis patients for Renji Hospital, Shanghai Jiao Tong University School of Medicine, China. Methods This study enrolled all maintenance hemodialysis （MHD） patients between 1 January, 2007 and 31 December, 2014 at the Renji Hospital. They were followed up until death, cessation of hemodialysis, transfer to other centers or to the end of the study （31 December, 2014）. Laboratory parameters, including hemoglobin concentrations, transferrin saturation, ferritin, serum albumin, were measured every 3 months. According to the Kidney Disease Outcomes Quality Initiative （K/DOQI） guidelines, the patients were divided into target-hemoglobin group （110〈~ Hb 〈~ 120 g/L） and non target-hemoglobin group （〈 110 g/L or 〉 120 g/L）, and then the compliance rate of Hb, Ferritin, transferrin saturation, and the influence factors of compliance rate of Hb as well as its relationship with the prognosis were analyzed. Results Total 517 maintenance hemodiatysis patients were involved in this study. The mean age was （63.76± 14.78） years and 59.96% patients were male. Only 35.20%, 91.26% and 31.18% of them met the K/DOQI defined targets for hemoglobin, transferrin saturation and ferritin levels. The average levels of TSAT and Ferritin had no significant difference between the target-hemoglobin group and the non target-hemoglobin group. Compared with patients in non target-hemoglobin group, the target- hemoglobin group had significantly higher qualified rate of transferrin saturation （94.97% vs 89.41%, P=0.045） and Ferritin （37.22% vs 28.13%, P=0.036）. Multivariate logistic regression analysis showed that the serum albumin, blood intact parathyroid hormone （iPTH） and dialysis vintage were independent risk factors that affected whether hemoglobin was up to the target. Kaplan-Meier analysis showed that the 8-year survival rate and cardiovascular survival rate in target-hemoglobin group were obviously higher than that in the non target-hemoglobin group （86.70% vs 75.30%, X^2Log rank=7.134, P=0.008; 93.80% vs 85.30%,X^2Log rank=6.134, P=0.013, respectively）. Dialysis frequency, age and ferritin were independent risk factors of all-cause mortality for non target- hemoglobin group, and Dialysis frequency was independent risk factors of cardio- eerebral vascular disease mortality for non target-hemoglobin group. Conclusions The compliance rate of hemoglobin in MHD patients is still not steady controlled. Blood iPTH, serum albumin and dialysis vintage are independent risk factors that affect whether hemoglobin is up to the target in MHD patients. Sub- standard hemoglobin increases both all- cause mortality and cardio- cerebral vascular disease mortality in MHD patients.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2016年第2期110-117,共8页
Chinese Journal of Nephrology
基金
上海交通大学医学院附属仁济医院南院临床学科创新共建平台建设项目，South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Clinical Innovation and Multi Discipline Integrated Medical Construction Project
