摘要
目的:了解四川各个地区维持性血液透析(MHD)患者血红蛋白(Hb)达标情况及铁代谢指标达标情况,为提高四川地区MHD患者贫血达标率提供参考。方法:纳入四川地区41个透析中心MHD患者7190例,搜集患者Hb、铁蛋白、转铁蛋白饱和度、总铁结合力等指标,分析MHD患者Hb达标率及铁代谢指标的分布情况。结果:入选的7190例患者中男性58.9%,中位年龄57(49~69)岁,Hb达标2451例,达标率34.1%(95%CI 33.0%~35.2%),不同地区的达标率有所差异(P<0.0001),川北地区31.8%(95%CI 29.5%~34.0%),川南地区36.8%(95%CI 34.2%~39.5%),川西地区30.1%(95%CI 27.6%~32.6%),川东地区36.1%(95%CI 33.4%~38.7%),川中地区35.9%(95%CI 33.6%~38.1%);Hb<110 g/L的患者共2292例,其中大细胞性贫血147例(14.4%),正细胞正色素性贫血751例(73.7%),单纯小细胞性贫血23例(2.3%),小细胞低色素性贫血98例(9.6%)。女性患者达标率32.0%(95%CI 30.4%~33.7%),男性患者达标率35.5%(95%CI 34.1%~37.0%),女性达标率低于男性,差异有统计学意义(P=0.002)。达标和未达标患者的性别差异有统计学意义(χ2=9.412,P=0.002)。三甲医院HD中心达标率33.2%(95%CI 31.5%~34.9%),非三甲医院34.7%(95%CI 33.3%~36.2%),差异无统计学意义;女性相较于男性,Hb未达标风险增加(OR=1.167,95%CI 1.057~1.290)。中位血清铁11.4(8.4~15.4)IU/mL,铁蛋白163.3(60.4~321.9)μg/L,转铁蛋白饱和度25.5%(18.8%~34.1%),总铁结合力48.4(39.5~56.8)μg/dL;绝对性铁缺乏患者占18.9%(16.9%~20.9%),Hb达标的患者占34.9%(29.2%~40.7%);非绝对性铁缺乏患者Hb达标的患者占比37.3%(34.5%~40.1%),差异无统计学意义。结论:四川地区的MHD患者Hb达标率低,存在地区差异,女性达标率低于男性,约1/4的MHD患者存在绝对性铁缺乏。
Objective:To investigate the compliance of hemoglobin and iron metabolism in maintenance hemodialysis(MHD)patients in various areas of Sichuan province,and to provide reference for improving the compliance rate of anemia in MHD patients in this area.Methodology:A total of 7190 MHD patients in 41 dialysis centers in Sichuan were enrolled in this study.Hemoglobin,ferritin,transferrin saturation,total iron binding capacity and other indicators were collected,to analyze the hemoglobin compliance rate and the distribution of iron metabolism parameters in MHD patients.Results:A total of 7190 patients in 41 hemodialysis centers were included in the final analysis,including 58.9%males,57(49~69)years of median age,2451 patients were reaching the standard,with a compliance rate of 34.1%(95%CI 33.0%~35.2%).The compliance rate was different in different regions(P<0.0001),31.8%(95%CI 29.5%~34.0%)in northern Sichuan,36.8%(95%CI 34.2%~39.5%)in southern Sichuan,30.1%(95%CI 27.6%~32.6%)in western Sichuan,36.1%(95%CI 33.4%~38.7%)in eastern Sichuan and 35.9%(95%CI 33.6%~38.1%)in central Sichuan.A total of 2292 patients had Hb<110 g/L,including 147(14.4%)with macrocytic anemia,751(73.7%)with normocytic normochromic anemia,23(2.3%)with microcytic anemia alone,and 98(9.6%)with microcytic hypochromic anemia.The compliance rate was 32.0%(95%CI 30.4%~33.7%)in female patients,35.5%(95%CI 34.1%~37.0%)in male patients.Women had a lower compliance rate than men,and the difference was statistically significant(P=0.002).There was a significant difference in gender(χ=9.412,P=0.002).The compliance rate of hemodialysis centers was 33.2%(95%CI 31.5%~34.9%)in tertiary hospitals and 34.7%(95%CI 33.3%~36.2%)in non-tertiary hospitals,the difference was not statistically significant(P=0.121);The risk of substandard hemoglobin was increased(OR=1.167,95%CI 1.057~1.290).Serum iron 11.4(8.4~15.4)IU/ml,ferritin 163.3(60.4~321.9)μg/L,transferrin saturation 25.5%(18.8%~34.1%),total iron binding capacity 48.4(39.5~56.8)μg/dL;patients with absolute iron defi
作者
李明珠
詹亚
蒲蕾
张月
何强
李贵森
王莉
洪大情
LI Mingzhu;ZHAN Ya;PU Lei;ZHANG Yue;HE Qiang;LI Guisen;WANG Li;HONG Daqing(Sichuan Province People's Hospital Affiliated to University of Electronic Science and Technology,Chengdu 610312,China;Sichuan Province Center for Quality,Control of Kidney Disease,Chengdu 610312,China)
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2022年第4期346-350,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
成都市金牛区医学会肾脏专委会专项科研课题计划(JNQN20-04)。
