维持血液透析患者不同血管通路类型与红细胞生成素剂量的相关性分析

摘要

Objective To investigate the association between the type of vascular access and erythropoietin(EPO)dose in maintenance hemodialysis(MHD)patients with targeted hemoglobin level. Methods We selected 115 patients on MHD met inclusion and exclusion criteria retrospectively during the period from January 2014 to June 2014 from three hospitals in Beijing and compared the difference of EPO dose between arteriovenous fistula(AVF)and central venous(CVC)group.Univariable analysis followed by multiple liner regression analysis was performed to identify the independent risk factors for EPO dose.Results There were similar serum ferritin,albumin,iPTH level between AVF and CVC patients.However,EPO dose were significant higher in CVC patients compared with AVF patients (P <0.05).It had been associated with increase in total weekly EPO dose by 27.5% in CVC patients. Conclusion The type of vascular access is an independent factor influencing EPO dose in MHD patients with targeted serum hemoglobin level.%目的：探讨维持血液透析患者在血红蛋白达标的情况下不同血管通路类型与红细胞生成素（EPO）剂量之间的关系。方法回顾性分析2014年1月～2014年6月北京三家医院血液净化中心115例维持血液透析患者的临床资料，比较自体动静脉内瘘（AVF）与中心静脉导管（CVC）血液透析患者的 EPO 剂量，采用单因素及多重线性回归分析分析影响 EPO 剂量的独立因素。结果115例患者中自体内瘘85例，中心静脉导管30例，两组患者血清白蛋白、铁蛋白、甲状旁腺激素水平及 Kt／v 比较差异无统计学意义。中心静脉导管患者标化 EPO 剂量明显高于内瘘患者[每周（151．03±55．11）IU ／kg 与（118．42±49．78）IU ／kg，P ＝0．003]。中心静脉导管患者每周平均 EPO 剂量较内瘘患者增加27．5％。结论血管通路类型是影响血液透析患者 EPO 剂量的独立因素，中心静脉导管患者较自体内瘘患者需要更多的 EPO 才能达到相同的血红蛋白目标值水平。