不同透析方式對CKD 5期患者HGB水平影響的橫斷面研究

張淑瑛　　蔣麗娟　　馬錦洪　　邵小南

[關鍵詞] 慢性腎臟病;血液透析;腹膜透析;血紅蛋白

[中圖分類號] R459.4? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 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）

慢性腎臟病（Chronic kidney disease，CKD）是世界范圍內的嚴重威脅人類健康的疾病[1-2]，可以保守治療也可使用替代療法[3]。腎臟替代療法包括血液透析（Hemodialysis，HD）、腹膜透析（Peritoneal dialysis，PD）和腎移植，是終末期腎病（End-stage renal disease，ESRD）患者的主要治療方法[4]。腎性貧血（Renal anemia，RA）是CKD患者常見的合并癥之一，會降低患者的生活質量，治療不及時會導致住院率和死亡率的增加[5-6]。隨著CKD的進展，反映貧血程度的HGB水平也出現不同程度的下降，幾乎所有的ESRD患者都患有貧血[7]。腎性貧血的原因多種多樣，例如促紅細胞生成素的生成減少、尿毒癥毒素積聚、紅細胞存活期縮短、骨髓纖維化、甲狀旁腺功能亢進癥、慢性炎癥等[8-9]。RA的處理很重要，為更好的評估CKD患者的貧血，指南中提出應長期隨訪HGB用于貧血的管理[10-11]。以往大多數的研究都集中在HD的人群上，有關PD患者貧血的研究相對較少，本研究旨在探討不同的透析方式對CKD5期患者的HGB水平的影響，現報道如下。