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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χ~2=207.112,P<0.001;6月χ~2=230.008,P<0.001;12月χ~2=189.613,P<0.001;24月χ~2=162.607,P<0.001;36月χ~2=168.074,P<0.001)。各时间点血红蛋白≥10g/d L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。
Objective To investigate the compliance rate of hemoglobin in peritoneal dialysis patients with different dialysis ages and its related factors to provide evidence for the clinical treatment of anemia in peritoneal dialysis patients. Methods All patients with complete dialysis ages ≥3 months who started regular peritoneal dialysis at Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January 2000 and May 2013 were enrolled. Hemoglobin 100 ~ 120g / L as the target range of patients at each time point to evaluate hemoglobin compliance rate and its related factors. Results A total of 521 patients were enrolled in this study. The pre-dialysis hemoglobin compliance rate was 14.8%, peritoneal dialysis 1, 6, 12, 24, 36 hemoglobin compliance rates were 36.3%, 40.7%, 43.8%, 42.1%, 42.6%, respectively, and pre-dialysis phase (P <0.01); χ ~ 2 = 230.008, P <0.001; χ ~ 2 = 189.613, P <0.001 in December; Month χ ~ 2 = 162.607, P <0.001; 36 months χ ~ 2 = 168.074, P <0.001). The proportion of hemoglobin≥10g / d L at each time point was 16.7%, 72.2%, 73.1%, 77.1%, 78.9% and 78.1% respectively. Multi-factor stepwise regression analysis showed that serum 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 independent independent factors of hemoglobin at 1 month of peritoneal dialysis. At 36 months of peritoneal dialysis, transferrin saturation (β = 0.494, P <0.001) and residual renal function (β = 0.182, P = 0.001) were independently associated with hemoglobin. Conclusion The perfor- mance of hemoglobin in peritoneal dialysis patients is significantly higher than that of pre-dialysis patients, but the overall compliance rate is still not satisfactory. Saturation of transferrin and residual renal function are the independent factors affecting hemoglobin level in peritoneal dialysis patients.