上海青浦地区维持性血液透析患者的现况调查

目的：了解上海郊县维持性血液透析（maintenance hemodialysis,MHD）患者的治疗状况,为优化郊县和农村地区的血液透析治疗提供依据。方法：2009年10月对上海市青浦区患者的治疗情况进行横断面调查。结果：共调查维持性血液透析治疗患者133例,其中男性73例,女性60例。患者年龄55.28±12.36（26~80）岁,透析龄40.71±30.56（3~131）个月。患者中高血压病患病率、治疗率和达标率分别为88.0%（117/133）、99.1%（116/117）和12.8%。49.6%的高血压病患者服用1种降压药,应用2种、3种和以上者分别占40.0%和10.4%。单药用药以钙通道阻滞剂最多（87.9%）,其次为血管紧张素受体阻断剂（22.9%）。贫血治疗的达标率为29.3%（39/133）。促红细胞生成素治疗率为94.7%,口服铁剂应用率为85.7%。患者血钙、血磷、钙磷乘积和甲状旁腺激素（iPTH）的治疗达标率依次为54.9%、25.6%、51.1%和32.3%;仅有5例（3.76%）上述4项指标均达到要求。患者中30.1%（40/133）的患者合并血吸虫肝病,前者较无血吸虫肝病患者年龄高（58.8±11.7岁比53.8±12.4岁,P〈0.05）,血清白蛋白和血红蛋白（hemoglobin,Hb）水平低（39.2±6.4g.L-1比41.1±3.1g.L-1;96.1±9.8g.L-1比99.9±10.0g.L-1,P〈0.05）。结论：上海青浦地区MHD患者合并血吸虫肝病、贫血、高血压病的患病率高且相应治疗不充分,血压和Hb的达标率低。相当比例的血液透析患者未能满意地控制钙磷代谢及继发性甲状旁腺功能亢进。

A Cross-Sectional Study Hemodialysis Patients in Shanghai Qingpu District

Objective：The purpose of this cross-sectional study was to survey the hemodialysis practices and outcomes in Qingpu district,which lies in the west suburbs of Shanghai,serving for the improvement of hemodialysis quantities in China suburbs and countries.Methods：The study was implemented in October 2009,for which 133 patients（73 male,60 female） from the outpatient hemodialysis center of Qingpu Branch,Zhongshan Hospital were included.Results：All the patients involved,with an average age of 55.28 12.36 years,received a minimum of 3 months＇ maintenance hemodialysis（MHD） therapy.Sixty five patients（49.6%）were eligible to get Shanghai citizen medicare.The prevalence of hypertension was 88.0%（117/133）,diagnosed as a pre-dialysis blood pressure over 140/90 mmHg.With an anti-hypertensive treatment rate of 99.1%,only 12.8% patients were under good control.Nearly half patients（49.6%） were treated with single anti-hypertensive drug,and 40.0% with 2 drugs,10.4% with 3 drugs or more.Calcium channel blocker（CCB） was the most frequently prescribed drug（87.90%）,followed by angiotensin II receptor blockers（22.4%）.Most patients（94.7%） received erythropoietin treatment while only thirty nine patients reached a target hemoglobin≥110 g·L-1.No patient received intravenous iron therapy while 85.7% patients taking oral iron supplementation.Kidney Disease Outcomes Quality Initiative（K/DOQI） targets for calcium,phosphate,calcium-phosphate product,intact parathyroid hormone（iPTH） and all 4 targets were met by 54.9%,25.6%,51.1%,32.3% and 3.76%,respectively.Forty of the 133 patients（30.1%） were complicated with schistosomal hepatopathy,for whom with an older age（58.8±11.7 year vs 53.8±12.4,P0.05）and a lower serum albumin and hemoglobin level（39.2±6.4 g·L-1 vs 41.1 3.1 g·L-1;96.1±9.8 g·L-1 vs 99.9±10.0 g·L-1,P0.05） than those without shistosomiasis.Conclutions：the prevalence of hypertension and anemia in MHD patients from Shanghai western suburbs are high while treatment of hypertension and anemia were both inadequate as most patients have not reached the therapeutic targets.Quite a few of patients do not achieve the K/DOQI bone mineral targets.Patients receiving MHD treatment in Qingpu district have a high prevalence of schistosomal hepatopathy.