目的 探讨新乡地区接受维持性血液透析的糖尿病患者与非糖尿病患者贫血现况及相关影响因素.方法 纳入2012年1月至2012年3月在新乡市第一人民医院、新乡市中心医院、河南宏力医院和辉县市人民医院接受维持性血液透析治疗3个月或以上的患者364例,其中男209例,女155例,年龄20~ 93岁,平均(52±l5)岁.将其分为糖尿病组[n=98,其中男44例,女54例,年龄23 ~ 85岁,平均(60±12)岁]和非糖尿病组[n=266,其中男165例,女101例,年龄20 ~ 93岁,平均(48±17)岁],分析两组患者贫血现况及其与促红细胞生成素、铁剂、营养不良、透析充分性、微炎症、甲状旁腺素的关系.采用t检验、x2检验和方差分析进行数据统计.结果 与非糖尿病组比较,糖尿病组患者贫血发生率显著升高(78.6% vs 67.3%,P<0.05),血红蛋白水平及血红蛋白达标率显著降低[(90±19) vs(96±23) g/L,21.4% vs 32.7%;均P<0.05].糖尿病组血白蛋白、前白蛋白、透析龄、甲状旁腺素水平明显低于非糖尿病组[(37±6)vs(39±5)g/L,(483±143) vs(586±138) mg/L,(23±22) vs(34±26)个月,(77±132) vs(155±240)pmol/L;均P<0.01],透析频率明显高于非糖尿病组[(9.9±1.8) vs(9.1±2.1)h/w,P<0.01],C反应蛋白及血钙水平明显高于非糖尿病组水平[(8±14)vs(3±10)mg/L,(2.0±0.4)vs(1.9±0.3) mmol/L;均P<0.05].促红细胞生成素治疗量、铁剂治疗率、铁指标达标率两组差异无统计学意义(均P>0.05).结论 在使用相同剂量的促红细胞生成素的情况下,接受维持性血液透析的糖尿病患者贫血发生率高,血红蛋白达标率低,贫血可能与炎症、营养不良有关,提示在给予充足的促红细胞生成素和铁剂治疗的同时,应加强患者营养治疗.
Objective To investigate present situation and related factors of anemia in patients with diabetic nephropathy who received maintenance hemedialysis (MHD).Methods A total of 364 patients who underwent MHD in four hospitals of Henan Province were enrolled and assigned to the diabetes group (n =98,male 44,female 54,mean age (60± 12) years old) and the non-diabetes group (n =266,male 165,female 101,mean age (48 ± 17) years old).Relationship between hemoglobin levels with erythropoietin(EPO),iron,malnutrition,adequacy of dialysis,inflammation and parathyroid hormone (PTH) was analyzedin all the participants.Student' s t test or Chi-square test was used for data analysis.Results Incidence of anemia was higher in the diabetes group than the non-diabetes group (78.6% vs 67.3%,P<0.05).The level of serum hemoglobin and the rote of hemoglobin target were significantly decreased in the diabetes group ((90 ± 19) vs(96 ± 23) g/L,21.4% vs 32.7%; both P < 0.05).The level of serum albumin,prealbumin,dialysis age and PTH were significantly lower,and the level of dialysis frequency wassignificantly higher in the diabetes group than the non-diabetes group ((37 ± 6) vs (39 ± 5) g/L,(483 ±143) vs (586 ± 138) mg/L,(23 ± 22) vs (34 ± 26) months,(77 ± 132) vs (155 ± 240) pmol/L; all P <0.01).Serum levels of CRP and calcium in the diabetes group were significantly higher than those in the non-diabetes group ((8± 14) vs (3± 10) mg/L,(2.0±0.4) vs (1.9±0.3) tmol/L; both P<0.05).There were no significant differences in EPO dose,treatment rate and standard rate of iron between the two groups (all P>0.05).Conclusion In the case of using the same dose of EPO,the incidence ofanemiais high and the rate of hemoglobin target is low in MHD patients with diabetes,which is associated with inflammation and malnutrition.It is important to treat anemic MHD patients with enough EPO and iron,in the meantime,more attention must be put to the treatment of malnutrition and inflammation.