论文部分内容阅读
目的了解维持血液透析患者贫血治疗达标情况并分析其影响因素。方法选择我院规律血液透析患者73例。按血红蛋白(hemoglobin,Hb)水平将患者分为3组:A组为Hb≥130 g/L患者;B组为110 g/L≤Hb<130g/L患者;C组为Hb<110 g/L患者。透析前采血检测肾功能、血常规、电解质、白蛋白(albumin,Alb)、C反应蛋白(C-reactive protein,CRP)、β2-微球蛋白(β2-microglobulin,β2-MG)、血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血清铁蛋白(serum ferritin,SF)等参数。记录最近4周重组人红细胞生成素(recombinant human erythropoietin,r-HuEPO)的应用总量,以每周应用总量同红细胞压积(hematocrit,Hct)的比值(r-HuEPO dosage to Hct,EPO/Hct)作为评价r-HuEPO低反应的指标。比较3组患者上述指标的差别,分析各因素与Hb的相关性。结果①73例患者中,Hb≥110 g/L者62例,占全部患者的84.93%。②EPO/Hct比值,B组患者明显高于A组患者(P<0.05)。③C组患者EPO/Hct比值、CRP、β2-MG及iPTH水平均高于A组和B组(P<0.05)。④其余各项指标三组间差异无统计学意义(P>0.05)。⑤单因素相关分析,Hb与ALB呈显著正相关(P<0.05);与EPO/Hct、β2-MG、CRP及iPTH呈显著负相关(P<0.05)。⑥多因素逐步线性回归分析:EPO/Hct、CRP、Alb和β2-MG是Hb的独立影响因素[标准回归系数(Beta)分别为-1.607,-3.391,0.612,-1.019]。结论 r-HuEPO低反应性是贫血治疗不达标的主要原因,患者微炎症水平、营养状态及中分子毒素的清除不足可能是其危险因素。
Objective To understand the maintenance of hemodialysis patients with anemia treatment compliance and analysis of its influencing factors. Methods Select our hospital regular hemodialysis patients 73 cases. Patients were divided into 3 groups according to hemoglobin (Hb) level: group A was Hb≥130g / L; group B was 110g / L≤Hb <130g / L; group C was Hb <110g / L patient. Pre-dialysis blood tests were performed on renal function, blood, electrolyte, albumin (Alb), C-reactive protein (CRP), β2-microglobulin (β2-MG) Intact parathyroid hormone (iPTH), serum ferritin (SF) and other parameters. The total amount of recombinant human erythropoietin (r-HuEPO) used in the last 4 weeks was recorded and the ratio of total weekly application to hematocrit (Hct) (r-HuEPO dosage to Hct, EPO / Hct) as an indicator of low response to r-HuEPO. The differences of the above indexes between the three groups were compared, and the correlation between each factor and Hb was analyzed. Results ① Of the 73 patients, 62 (Hb≥110 g / L) accounted for 84.93% of all patients. ② The ratio of EPO / Hct in group B was significantly higher than that in group A (P <0.05). ③ The EPO / Hct ratio, CRP, β2-MG and iPTH in group C were higher than those in group A and B (P <0.05). ④ The remaining indicators of the three groups showed no significant difference (P> 0.05). ⑤Univariate analysis showed that there was a significant positive correlation between Hb and ALB (P <0.05) and negative correlation with EPO / Hct, β2-MG, CRP and iPTH (P <0.05). ⑥multi-factor stepwise linear regression analysis: EPO / Hct, CRP, Alb and β2-MG are independent influencing factors of Hb [standard regression coefficient (-1.607, -3.391,0.612, -1.019] respectively. Conclusions The low reactivity of r-HuEPO is the main reason for anemia treatment failure. The level of micro-inflammation, nutritional status and the deficiency of moderate toxin may be the risk factors.