2020年山西省腹膜透析患者贫血的流行病学调查及相关因素分析

doi:10.3877/cma.j.issn.2095-3216.2023.03.001

目的

对山西省腹膜透析(PD)患者的贫血进行流行病学调查并分析相关因素。

方法

筛选2020年全国血液净化病例登记系统的山西省PD患者病例，收集基本资料、透析状况、药物使用及实验室指标。血红蛋白(Hb)≥110 g/L视为治疗达标。

结果

2020年山西省PD患者血红蛋白(Hb)水平为(104.9±18.3)g/L，Hb总体达标率为40.2%。红细胞生成刺激剂使用率为97.1%，口服铁剂使用率为98.3%，静脉铁剂使用率为1.7%。男性Hb达标率高于女性；随年龄增长，Hb达标率呈增高趋势。与Hb达标患者相比，Hb未达标组患者的女性比例、透析龄、每周红细胞生成刺激剂剂量，持续不卧床PD患者每日透析液剂量、血肌酐及血磷较高，而平均年龄、职业稳定程度、血钙及血白蛋白较低(均P<0.05)。多因素Logistic回归分析显示，年龄<45岁、甲状旁腺激素>500 ng/L和血白蛋白<35 g/L为Hb未达标的风险因素。

结论

2020年山西省PD患者Hb≥110 g/L者占40.2%。年龄<45岁、甲状旁腺激素>500 ng/L、血白蛋白<35 g/L为Hb未达标的风险因素。加强年轻患者的健康宣教和慢病管理，调节好钙磷代谢，控制继发性甲状旁腺功能亢进及增强营养，可能有助于改善山西省PD患者的贫血情况。

关键词: 腹膜透析, 肾性贫血, 血红蛋白, 红细胞生成刺激素, 风险因素

Objective

To perform epidemiological investigation on anemia in peritoneal dialysis (PD) patients in Shanxi Province in 2020 and analyze related factors.

Methods

Data of PD patients in Shanxi Province in 2020, registered in the Chinese National Renal Data System (CNRDS), were collected including basic information, dialysis status, drug use, and laboratory indicators. Hemoglobin (Hb)≥110 g/L was regarded as Hb level success.

Results

In 2020, the average Hb level of PD patients in Shanxi Province was (104.9±8.3) g/L, and the overall rate of Hb level success was 40.2%. The usage rate of erythropoietic stimulating agents (ESAs) was 97.1%. The usage rate of oral iron was 98.3%, while the usage rate of intravenous iron was 1.7%. The Hb level success rate was higher in the male than in the female patients. The Hb level success rate increased with age. Compared with the patients with Hb level success, those patients without Hb level success showed higher levels in the proportion of females, age of dialysis, weekly dose of ESAs, daily dialysate dose of patients with continuous ambulatory PD (CAPD), serum creatinine, and serum phosphorus, but lower levels in the average age, occupational stability, serum calcium, and serum albumin (all P<0.05). Multivariate logistic regression analysis showed that age<45 years old, parathyroid hormone >500 ng/L, and serum albumin <35 g/L were risk factors for the Hb level without success.

Conclusion

In Shanxi Province in 2020, 40.2% PD patients had an Hb level of no less than 110 g/L. The risk factors for the Hb level to be less than 110 g/L included the age <45 years old, parathyroid hormone >500 ng/L, and serum albumin <35 g/L. Strengthening health education and chronic disease management for the young PD patients, well regulating calcium and phosphorus metabolism, controlling secondary hyperparathyroidism, and enhancing nutrition may be helpful to improve the anemia situation in the PD patients in Shanxi Province.

Key words: Peritoneal dialysis, Renal anemia, Hemoglobin, Erythropoietic stimulating agents, Risk factors

表1 患者一般临床资料及治疗情况对比

指标	未达标组	达标组	t/χ²/Z值	P值
性别(男/女)^a	45.7%/54.3%	55.1%/44.9%	4.138	0.042
年龄(岁)^b	49.74±14.75	52.56±15.3	2.036	0.042
教育程度[例(%)]^a			2.160	0.340
大专及以上	23(11.6)	17(12.0)
高中及中专	45(22.6)	23(16.2)
初中及以下	131(65.8)	102(71.8)
职业[例(%)]^a			5.273	0.022
稳定	51(34.2)	51(48.6)
不稳定	98(65.8)	54(51.4)
体质指数(kg/m²)^b	22.71±3.43	23.11±3.19	1.199	0.231
原发病[(例)%]^a			2.049	0.359
原发性肾小球病	189(79.7)	120(74.0)
高血压病	30(12.7)	24(14.8)
糖尿病	18(7.6)	18(11.2)
透析龄(月)^b	31.73±26.27	25.46±21.50	－2.778	0.006
透析前收缩压(mmHg)^b	141.7±22.17	137.8±18.17	－1.928	0.055
透析方式[(例)%]^a			3.085	0.214
CAPD	211(92.5)	143(87.7)
IPD	10(4.4)	14(8.6)
TPD	7(3.1)	6(3.7)
CAPD每日透析液剂量(L)^c	7.54±1.5	6.92±1.52	－3.451	0.01
透析液类型[(例)%]^a			1.498	0.221
国产	90(38.8)	75(44.9)
进口	142(61.2)	92(55.1)
总肌酐清除率[(例)%]^a			0.61	0.805
<50	47(29.6)	42(30.9)
≥50	112(70.4)	94(69.1)
总尿素清除分数[(例)%]^a			0.234	0.628
<1.7	55(34.6)	50(37.3)
≥1.7	104(65.4)	84(62.7)
腹膜平衡实验[(例)%]^a			5.493	0.139
高转运	7(9.6)	5(8.3)
高平均转运	35(47.9)	18(30.0)
低平均转运	29(39.8)	33(55.0)
低转运	2(2.7)	4(6.7)
ESAs使用种类^a			0.858	0.354
国产	186(95.4)	102(91.9)
进口	9(4.6)	9(8.1)
每周ESAs剂量(U)^b	7492.17±2914.09	6454.24±2791.82	－2.287	0.024
口服铁剂[(例)%]^a	77(26.5)	41(20.9)	1.959	0.162
血总钙(mmol/L)^b	2.19±0.21	2.25±0.26	2.447	0.015
血磷(mmol/L)^c	1.63±0.47	1.54±0.42	－2.272	0.023
血甲状旁腺激素(ng/L)^c	395.13±291.14	306.41±291.14	－0.286	0.004
血尿素氮(mmol/L)^c	19.71±6.00	20.10±8.44	－0.393	0.694
血肌酐(μmol/L)^b	848.74±294.98	735.97±244.80	－3.839	0.000
血尿酸(μmol/L)c	388.22±241.34	364.25±82.13	－1.315	0.188
血白蛋白(g/L)^b	33.89±5.31	35.59±4.41	3.716	0.000
血胆固醇(mmol/L)^c	4.54±1.06	5.50±1.13	－0.175	0.861
血甘油三酯(mmol/L)^c	1.82±1.25	1.69±0.76	－0.400	0.689
血碳酸氢根浓度(mmol/L)^b	25.73±3.87	26.06±3.02	0.750	0.454
血C反应蛋白(mg/L)^c	4.60±12.92	0.96±1.25	－0.811	0.481

表1 患者一般临床资料及治疗情况对比

指标	未达标组	达标组	t/χ²/Z值	P值
性别(男/女)^a	45.7%/54.3%	55.1%/44.9%	4.138	0.042
年龄(岁)^b	49.74±14.75	52.56±15.3	2.036	0.042
教育程度[例(%)]^a			2.160	0.340
大专及以上	23(11.6)	17(12.0)
高中及中专	45(22.6)	23(16.2)
初中及以下	131(65.8)	102(71.8)
职业[例(%)]^a			5.273	0.022
稳定	51(34.2)	51(48.6)
不稳定	98(65.8)	54(51.4)
体质指数(kg/m²)^b	22.71±3.43	23.11±3.19	1.199	0.231
原发病[(例)%]^a			2.049	0.359
原发性肾小球病	189(79.7)	120(74.0)
高血压病	30(12.7)	24(14.8)
糖尿病	18(7.6)	18(11.2)
透析龄(月)^b	31.73±26.27	25.46±21.50	－2.778	0.006
透析前收缩压(mmHg)^b	141.7±22.17	137.8±18.17	－1.928	0.055
透析方式[(例)%]^a			3.085	0.214
CAPD	211(92.5)	143(87.7)
IPD	10(4.4)	14(8.6)
TPD	7(3.1)	6(3.7)
CAPD每日透析液剂量(L)^c	7.54±1.5	6.92±1.52	－3.451	0.01
透析液类型[(例)%]^a			1.498	0.221
国产	90(38.8)	75(44.9)
进口	142(61.2)	92(55.1)
总肌酐清除率[(例)%]^a			0.61	0.805
<50	47(29.6)	42(30.9)
≥50	112(70.4)	94(69.1)
总尿素清除分数[(例)%]^a			0.234	0.628
<1.7	55(34.6)	50(37.3)
≥1.7	104(65.4)	84(62.7)
腹膜平衡实验[(例)%]^a			5.493	0.139
高转运	7(9.6)	5(8.3)
高平均转运	35(47.9)	18(30.0)
低平均转运	29(39.8)	33(55.0)
低转运	2(2.7)	4(6.7)
ESAs使用种类^a			0.858	0.354
国产	186(95.4)	102(91.9)
进口	9(4.6)	9(8.1)
每周ESAs剂量(U)^b	7492.17±2914.09	6454.24±2791.82	－2.287	0.024
口服铁剂[(例)%]^a	77(26.5)	41(20.9)	1.959	0.162
血总钙(mmol/L)^b	2.19±0.21	2.25±0.26	2.447	0.015
血磷(mmol/L)^c	1.63±0.47	1.54±0.42	－2.272	0.023
血甲状旁腺激素(ng/L)^c	395.13±291.14	306.41±291.14	－0.286	0.004
血尿素氮(mmol/L)^c	19.71±6.00	20.10±8.44	－0.393	0.694
血肌酐(μmol/L)^b	848.74±294.98	735.97±244.80	－3.839	0.000
血尿酸(μmol/L)c	388.22±241.34	364.25±82.13	－1.315	0.188
血白蛋白(g/L)^b	33.89±5.31	35.59±4.41	3.716	0.000
血胆固醇(mmol/L)^c	4.54±1.06	5.50±1.13	－0.175	0.861
血甘油三酯(mmol/L)^c	1.82±1.25	1.69±0.76	－0.400	0.689
血碳酸氢根浓度(mmol/L)^b	25.73±3.87	26.06±3.02	0.750	0.454
血C反应蛋白(mg/L)^c	4.60±12.92	0.96±1.25	－0.811	0.481

表2 影响Hb未达标的多因素Logistic回归分析

指标	回归系数	Wald卡方	P值	OR值	95%CI
年龄<45岁	0.481	4.632	0.031	1.617	1.044~2.506
甲状旁腺激素>500 ng/L	0.590	5.273	0.022	1.804	1.090~2.986
血白蛋白<35 g/L	0.556	0.202	0.006	1.744	1.173~2.593
常量	－0.058	0.122	0.727	0.943

表2 影响Hb未达标的多因素Logistic回归分析

指标	回归系数	Wald卡方	P值	OR值	95%CI
年龄<45岁	0.481	4.632	0.031	1.617	1.044~2.506
甲状旁腺激素>500 ng/L	0.590	5.273	0.022	1.804	1.090~2.986
血白蛋白<35 g/L	0.556	0.202	0.006	1.744	1.173~2.593
常量	－0.058	0.122	0.727	0.943

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Epidemiological investigation and related factors analysis of anemia in peritoneal dialysis patients in Shanxi Province in 2020

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Epidemiological investigation and related factors analysis of anemia in peritoneal dialysis patients in Shanxi Province in 2020