初诊慢性肾脏病3~5期非透析患者贫血状况调查及影响因素分析-现代医学

初诊慢性肾脏病3~5期非透析患者贫血状况调查及影响因素分析

单位：乐山市人民医院肾病内科, 四川乐山 614000

分类号：R692

出版年·卷·期（页码）：2023·51·第二期（210-215）

摘要：

目的：了解初诊慢性肾脏病（CKD）3~5期非透析患者的贫血状况，分析贫血的影响因素。方法：选取2016年2月至2021年6月在乐山市人民医院肾病内科住院治疗的初诊CKD3~5期非透析患者，收集其贫血治疗前的首次实验室检查指标，调查初诊CKD3~5期非透析患者的贫血状况。根据Hb水平将入选患者分为贫血组和无贫血组，比较两组相关实验室检查指标的差异，采用多因素Logistic回归分析贫血的影响因素。结果：（1）525例初诊CKD3~5期非透析患者的贫血总患病率为87.8%，轻、中、重度贫血在贫血患者中的比例依次为48.2%、44.7%、7.1%；（2）各期贫血患病率依次为61.2%、90.4%、98.9%，贫血形态主要为正细胞正色素贫血。多因素Logistic回归显示女性性别、低白蛋白血症及CKD分期恶化是贫血的独立危险因素，高甘油三酯血症则是贫血的保护因素。结论：初诊CKD3~5期非透析患者普遍存在贫血，其患病率和CKD分期密切相关，其影响因素可能取决于CKD分期恶化、低白蛋白血症、女性性别和高甘油三酯血症。

Objective: To investigate the anemia status and its influencing factors in newly diagnosed non-dialysis patients with stage 3-5 chronic kidney disease(CKD). Methods: The newly diagnosed non-dialysis patients with stage 3-5 CKD who were hospitalized in the department of nephrology, People's Hospital of Leshan from February 2016 to June 2021 were enrolled. The indexes of first laboratory examination before anemia treatment were collected to investigate the anemia status in newly diagnosed non-dialysis patients with stage 3-5 CKD.The enrolled patients were then divided into anemia group and non-anemia group based on Hemoglobin(Hb) level. The differences of related laboratory examination indexes between the two groups were compared, and the influencing factors of anemia were analyzed by multivariate logistic regression analysis. Results: (1)The total prevalence of anemia in 525 stage 3-5 CKD patients was 87.8%, and the proportions of mild, moderate and severe anemia were 48.2%, 44.7% and 7.1%, respectively.(2)The prevalence of anemia in each stage was 61.2%, 90.4% and 98.9%, respectively. The anemia form was mainly normocytic-normochromic anemia. Multivariate logistic regression analysis showed that female sex, hypoalbuminemia, and CKD stage deterioration were independent risk factors for anemia, while hypertriglyceridemia was a protective factor for anemia. Conclusion: Anemia is common in newly diagnosed non-dialysis patients with stage 3-5 CKD. The prevalence of anemia are closely related to the stage of CKD, and the deterioration of CKD stage, hypoalbuminemia, female sex and hypertriglyceridemia are influencing factors.

参考文献：

[1] SHEN Y, WANG J, YUAN J, et al.Anemia among Chinese patients with chronic kidney disease and its association with quality of life-results from the Chinese cohort study of chronic kidney disease(C-STRIDE)[J].BMC Nephrol, 2021, 22(1):64.
[2] KUNG W M, YUAN S P, LIN M S, et al.Anemia and the risk of cognitive impairment:an updated systematic review and meta-analysis[J].Brain Sci, 2021, 11(6):777.
[3] LIN R J, EVANS A T, CHUSED A E, et al.Anemia in general medical inpatients prolongs length of stay and increases 30-day unplanned readmission rate[J].South Med J, 2013, 106(5):316-320.
[4] 孟磊, 丁文惠, 史力斌, 等.慢性肾脏病患者发生心血管事件危险因素的研究[J].中华心血管病杂志, 2009, 37(1):53-55.
[5] HOSHINO J, MUENZ D, ZEE J, et al.Associations of hemoglobin levels with health-related quality of life, physical activity, and clinical outcomes in persons with stage 3-5 nondialysis CKD[J].J Ren Nutr, 2020, 30(5):404-414.
[6] 郑颖.中国慢性肾脏病住院患者临床特征及高血压现状研究[D].北京:军医进修学院, 2012:111-116.
[7] 中华医学会肾脏病学分会肾性贫血诊断和治疗共识专家组.肾性贫血诊断与治疗中国专家共识(2018修订版)[J].中华肾脏病杂志, 2018, 34(11):860-866.
[8] 尚红.中华医学百科全书·实验诊断学[M].第1版.北京:中国协和医科大学出版社, 2019.
[9] LEVEY A S, STEVENS L A, SCHMID C H, et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med, 2009, 150(9):604-612.
[10] 中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志, 2016, 31(10):937-950.
[11] RYU S R, PARK S K, JUNG J Y, et al.The prevalence and management of anemia in chronic kidney disease patients:result from the KreaN cohort study for outcomes in patients with chronic kidney disease(KNOW-CKD)[J].J Korean Med Sci, 2017, 32(2):249-256.
[12] SALMAN M, KHAN A H, ADNAN A S, et al.Prevalence and management of anemia in pre-dialysis Malaysian patients:a hospital-based study[J].Rev Assoc Med Bras(1992), 2016, 62(8):742-747.
[13] LI Y, SHI H, WANG W M, et al.Prevalence, awareness, and treatment of anemia in Chinese patients with nondialysis chronic kidney disease:first multicenter, cross-sectional study[J].Medicine(Baltimore), 2016, 95(24):e3872.
[14] AFSHAR R, SANAVI S, SALIMI J, et al.Hematological profile of chronic kidney disease(CKD) patients in Iran, in pre-dialysis stages and after initiation of hemodialysis[J].Saudi J Kidney Dis Transpl, 2010, 21(2):368-371.
[15] 胡建芬, 罗海燕, 隆彩霞, 等.儿童川崎病低蛋白血症与炎症反应及肝功能的关系研究[J].儿科药学杂志, 2015, 21(1):3-5.
[16] 阿勇, 党宗辉, 次仁罗布, 等.西藏地区慢性肾脏病患者贫血现状调查[J].中华肾脏病杂志, 2016, 32(12):928-930.
[17] 赵冰, 张文静, 尹秀秀, 等.青年贫血和血脂相关性研究[J].中国卫生检验杂志, 2016, 26(13):1829-1832.
[18] 李君, 李志芳, 侯金友, 等.开滦健康体检人群贫血患病率调查及影响因素分析[J].中华内科杂志, 2018, 57(5):335-339.

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