不同透析方式对CKD 5期患者HGB水平影响的横断面研究

张淑瑛　　蒋丽娟　　马锦洪　　邵小南

[关键词] 慢性肾脏病;血液透析;腹膜透析;血红蛋白

[中图分类号] R459.4          [文献标识码] B          [文章编号] 1673-9701（2021）21-0120-06

Cross-sectional study of effect of different dialysis methods on HGB levels in patients with CKD Stage 5

ZHANG Shuying1   JIANG Lijuan1   MA Jinhong1   SHAO Xiaonan2

1.Department of Laboratory Medicine， the Third Affiliated Hospital of Soochow University， Changzhou   213003， China; 2.Department of Nuclear Medicine， the Third Affiliated Hospital of Soochow University， Changzhou   213003， China

[Abstract] Objective To explore the effect of different dialysis methods on hemoglobin （HGB） levels in patients with chronic kidney disease （CKD） stage 5. Methods A total of 835 patients with CKD stage 5 in the Department of Nephrology， the Third Affiliated Hospital of Soochow University from February 2014 to December 2019 were retrospectively analyzed. According to dialysis methods， they were divided into the non-dialysis group （273 patients）， the hemodialysis （HD） group （384 patients）， and the peritoneal dialysis （PD） group （178 patients）. The general data and laboratory indicators on admission of the three groups were collected. Results For HGB， statistically significant differences were observed among the three groups （P<0.05）， with the HD group [（95.3±22.6）g/L] >the PD group [（93.7±20.1）g/L] > the non-dialysis group [（85.7±21.4）g/L]. After adequate adjustment for confounding factors， differences in dialysis methods were significantly associated with the increased HGB，with the regression coefficient β of 5.328 （95%CI：1.487-9.168， P=0.007）， especially for that of the PD group relative to the non-dialysis group，with the regression coefficient β of 11.293 （95%CI： 3.469-19.009， P=0.005）. The curve fitting showed that the level of HGB increased gradually with different dialysis methods， which were 81.9 g/L in the non-dialysis group （95%CI： 76.1-87.7）， 84.7 g/L in the HD group （95%CI： 79.3-90.2）， and 93.2 g/L in the PD group （95%CI： 86.2-100.1）， and the HGB level was the highest in PD group. Conclusion Different dialysis methods can affect the level of HGB in CKD stage 5 patients，and PD has the least effect on HGB.

[Key words] Chronic kidney disease; Hemodialysis （HD）; Peritoneal dialysis （PD）; Hemoglobin （HGB）

慢性腎脏病（Chronic kidney disease，CKD）是世界范围内的严重威胁人类健康的疾病[1-2]，可以保守治疗也可使用替代疗法[3]。肾脏替代疗法包括血液透析（Hemodialysis，HD）、腹膜透析（Peritoneal dialysis，PD）和肾移植，是终末期肾病（End-stage renal disease，ESRD）患者的主要治疗方法[4]。肾性贫血（Renal anemia，RA）是CKD患者常见的合并症之一，会降低患者的生活质量，治疗不及时会导致住院率和死亡率的增加[5-6]。随着CKD的进展，反映贫血程度的HGB水平也出现不同程度的下降，几乎所有的ESRD患者都患有贫血[7]。肾性贫血的原因多种多样，例如促红细胞生成素的生成减少、尿毒症毒素积聚、红细胞存活期缩短、骨髓纤维化、甲状旁腺功能亢进症、慢性炎症等[8-9]。RA的处理很重要，为更好的评估CKD患者的贫血，指南中提出应长期随访HGB用于贫血的管理[10-11]。以往大多数的研究都集中在HD的人群上，有关PD患者贫血的研究相对较少，本研究旨在探讨不同的透析方式对CKD5期患者的HGB水平的影响，现报道如下。