【摘要】目的比较武汉地区不同血管通路的维持性血液透析(maintenance hemodialysis，MHD)患者之间血红蛋白(hemoglobin，Hb)水平的差异，并分析其相关性。方法以武汉市血液透析质量控制平台中40 家透析单位的MHD 患者为研究对象，收集患者一般情况及生化指标等资料。筛选出3792 例患者纳入研究，根据患者血管通路不同分为动静脉内瘘组(arteriovenous fistula，AVF)和非AVF 组，比较2 组Hb 水平及其他项目的差异，分析血管通路对患者Hb 的影响。结果①一般情况比较显示，AVF 组单室尿素清除率(spKt/V)中位数明显高于非AVF 组(χ2=3.358，P =0.001)；②AVF 组血红蛋白、白蛋白、尿素氮、钙平均值较非AVF 组高(t 值分别为5.522、13.297、11.51，2.895，P 值分别为＜0.001、＜0.001、＜0.001、0.004)，肌酐、磷、甲状旁腺素对数的平均值较非AVF 组低(t 值分别为- 17.720、- 8.309、- 3.773，P 值分别为＜0.001、＜0.001、＜0.001)；③Pearson 相关分析结果得出，AVF 组HB 与白蛋白(r=0.268，P ＜0.001)、钙(r=0.117，P ＜0.001)呈正相关，与磷(r=-0.077，P=0.008)、甲状旁腺素对数(r= -0.061，P =0.002)呈负相关；非AVF 组HB 水平与白蛋白(r =0.301，P＜0.001)，与肌酐(r=-0.131，P =0.006) 呈负相关；④ AVF 组贫血(HB＜100g/L) 比例(32.2% ) 低于非AVF 组(39.1% ) (χ2=16.043，P＜0.001)；⑤在校正各种混杂因素后的Logstic 回归模型中显示，AVF 的患者发生贫血(Hb＜100g/L)的风险较非AVF 患者低19.5%(OR=0.805，95% CI: 0.752～0.956,P =0.043)。结论血管通路为AVF 的患者HB水平较非AVF 患者高，且发生贫血的风险更低。
【Abstract】Objective To compare the difference of hemoglobin concentration (HB) and its related factors among maintenance hemodialysis (MHD) patients with two methods of vascular access (AVF and non-AVF) in Wuhan district. Methods The MHD patients from 40 dialysis units in Wuhan district were recruited as the research objects. Their general clinical information and biochemical indicators were collected. A total of 3,792 patients were enrolled in this study and divided into AVF group and non-AVF group. HB and other parameters were compared between the two groups. The effect of vascular access method on HB was then analyzed. Result ①The median value of spKt/V was significantly higher in AVF group than in non-AVF group (χ2=3.358, P=0.001). ②The average levels of HB, ALB, BUN and Ca were significantly higher in AVF group than in non- AVF group (t= 5.522, 13.297, 11.51 and 2.895 respectively; P＜0.001, ＜0.001, ＜0.001 and 0.004 respectively); while the average levels of Cr, P and logarithm value of PTH were significantly lower in AVF group than in non-AVF group (t=- 17.720, - 8.309 and - 3.773 respectively; P＜0.001, ＜0.001 and ＜0.001 respectively). ③ Pearson correlation analysis showed that HB was positively correlated with ALB (r=0.268, P＜0.001) and Ca (r=0.117, P＜0.001) and negatively correlated with P (r=-0.077, P=0.008) and logarithm value of PTH (r=-0.061, P=0.002) in AVF group; HB was negatively correlated with ALB (r=0.301, P＜0.001) and Cr (r=-0.131, P=0.006) in non-AVF group. ④The proportion of anemia (HB＜100g/L) was lower in AVF group than in non-AVF group (32.2% vs. 39.1%, χ2=16.043, P＜0.001). ⑤Logistic regression model after correcting various confounded factors showed that the risk of anemia in MHD patients with AVF was 19.5% lower than that in patients without AVF (OR=0.805, 95% CI 0.752～0.956, P=0.043). Conclusion HB level was higher and the risk of anemia was lower in MHD patients using AVF as blood access, as compared to those using the blood access routes other than AVF.
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