摘要
目的探讨维持性血液透析(MHD)患者的临床特征及透析指标的达标情况。方法对2016年11月开始于肾内科行MHD治疗的终末期肾病患者进行横断面研究。观察指标包括一般情况、透析前C-反应蛋白(CRP)、血红蛋白(Hb)、血钙、血磷、甲状旁腺激素(PTH)、白蛋白(Alb)、尿素氮(BUN)、血肌酐(Scr)等;并以年龄、糖尿病分层进行组间临床特征及透析指标比较。结果 (1)共纳入67例患者,60岁以上患者35例(52.2%),透析时长(13.3±4.6)月,主要病因为慢性肾小球肾炎44例(65.7%),其次为糖尿病肾病10例(14.9%)。(2)CRP<5 mg/L的患者41例,达标率为61.2%;110 g/L≤Hb<130 g/L的患者30例,达标率为44.8%;2.1 mmol/L≤血钙≤2.37 mmol/L的患者39例,达标率为58.2%;1.13 mmol/L≤血磷≤1.78 mmol/L的患者33例,达标率为49.3%;钙磷乘积<55 mg/dl的患者45例,达标率为67.2%;150 ng/L≤PTH≤300 ng/L的患者27例,达标率为40.3%;Alb>35 g/L的患者63例,达标率为94.0%。(3)老年患者Alb、血钙、血磷、PTH、BUN及Scr水平明显低于非老年患者(P<0.05,P<0.01)。(4)糖尿病组与非糖尿病组患者Scr水平均增高,但非糖尿病肾病患者Scr水平明显高于糖尿病肾病患者(Z=2.173,P=0.03)。其余透析指标比较无统计学差异(P均>0.05)。结论 MHD对终末期肾病患者具有较好效果,"微炎症状态"及肾性贫血得到较好控制;营养状况良好;血钙、血磷、PTH达标率高;对糖尿病肾病患者更加符合透析要求;对老年患者,应合理选择个体化的治疗方案,尽可能改善老年患者的长期预后。
Objective To investigate the clinical characteristics and the attainment of dialysis indexes in maintenance hemodialysis ( MHD) patients with end-stage renal disease.Methods A cross-sectional investigation was performed on MHD patients treated in the nephrology department from November 2016.General condition, c-reactive protein ( CRP), hemoglobin ( HB),serum calcium ( Ca),serum phosphorus ( P),parathyroid hormone ( PTH),albumin ( Alb),blood urea nitrogen ( BUN) and serum creatinine ( Scr) were observed;the clinical characteristics and dialysis indicators were compared among groups based on age and diabetes stratification.Results ( 1) Out of 67 patients involved, 35 patients ( 52.2%) were over 60 years old.The average duration of dialysis was ( 13.3 ± 4.6) months.The main cause of end-stage renal disease was chronic glomerulonephritis ( 65.7%), followed by diabetic nephropathy ( 14.9%).( 2) The attainment rates of CRP(< 5 mg /L),HB( 110 g /L≤HB < 130 g /L),Ca( 2.1 mmol /L≤Ca≤2.37 mmol /L),P( 1.13 mmol /L≤P≤ 1.78 mmol /L),calcium-phosphorus product (< 55 mg /dl), PTH( 150 ng /L≤PTH≤300 ng /L), Alb(> 35 g /L) were respectively 61.2%( 41 patients), 44.8%( 30 patients), 58.2%( 39 patients), 49.3%( 33 patients), 67.2%( 45 patients),94.0%( 63 patients).( 3) The levels of Alb, Ca, P, PTH, BUN and Scr in elderly patients were significantly lower than those in non-elderly patients ( P < 0.05,P < 0.01).( 4) Scr level increased in both diabetic and non-diabetic groups,but it was significantly higher in non-diabetic nephropathy patients than that in diabetic nephropathy patients ( Z = 2.173,P = 0.03).There were no significant differences in other dialy sis indicators ( all P > 0.05).Conclusions MHD has a good effect on patients with end-stage renal disease and well controls“micro-inflammatory state”and renal anemia.The nutritional statu of patients is good with higher standard rates of calcium, phosphorus and PTH.The patients with diabetic nephropathy are more in line with the requirements of dialysis.The i
作者
李丽
黄健
顾宏晨
王娟
沈颖婧
徐成钢
陶煜
LI Li;HUANG Jian;GU Hong-chen;WANG Juan;SHEN Ying-jing;XU Cheng-gang;TAO Yu(Department of Nephrology,Third Affiliated Hospital of Second Military Medical University,Shanghai 200438,China)
出处
《中国临床研究》
CAS
2019年第5期637-641,共5页
Chinese Journal of Clinical Research
关键词
终末期肾病
维持性血液透析
血液透析滤过
横断面调查
微炎症状态
End-stage renal disease
Maintenance hemodialysis
Hemodiafiltration
Cross-sectional study
Microinflammatory state
