老年维持性血液透析患者临床分析

目的了解上海交通大学医学院附属瑞金医院老年维持性血液透析（MHD）患者的临床特点。方法收集上海交通大学医学院附属瑞金医院血液透析中心目前存活的老年（≥60岁）MHD患者资料共111例。对其人口学资料、血压、实验室指标、透析相关参数、透析充分性进行分析。并根据其血红蛋白水平，按照高血红蛋白组（Hb≥110g／L）及低血红蛋白组（Hb〈110g／L）进行比较探讨。结果（1）111例老年MHD患者平均年龄为（69．4±6．8）岁，男性占64．0％（71／111），中位透析龄为3年，原发性肾小球。肾病占54．1％（60／111）、糖尿病肾病患者占13．5％（15／111）。（2）111例患者透前血压为（142．3±16．2／77．7±8．2）mmHg，达标率为39．6％（44／111）；血红蛋白水平为（107．9±17．2）g／L；钙磷乘积为（4．1±1．7）mmol^2／L^2；iPTH水平为266．1±259．2pg／mL，达标率为27．9％（31／111）；白蛋白为（34．5±4．9）g／L；spKt／v达标率为72．1％（80／111）。（3）低血红蛋白组与高血红蛋白组比较，其糖尿病。肾病患者比例较高、血肌酐水平较低、透析时血流量较慢，P值〈0．05；其他实验室指标如铁蛋白、钙磷、iPTH、白蛋白及血压水平、年龄、性别比等无统计学差异。（4）尽管高血红蛋白组患者血肌酐水平较高，但其干体重、超滤量、透析充分性等指标与低血红蛋白组无统计学差异，前白蛋白水平略高。结论（1）老年MHD患者以男性为主，原发性。肾小球肾病仍是主要原发病，但应重视糖尿病肾病患者增多带来的挑战。（2）老年MHD患者透析充分性相对较为满意，但对CKD并发症的控制有待加强。（3）提高老年MHD患者的营养水平、鼓励蛋白质摄入可能有助于贫血的纠正，需要进一步的临床观察予以验证。

Clinical characteristics of elderly maintenance hemodialysis patients

Objective To investigate the clinical characteristics of elderly maintenance hemodialysis （MHD） patients. Methods The clinical and laboratory data of elderly MHD patients were collected and analyzed, which were compared according to different hemoglobin levels. Results 111 elderly MHD patients, with M/F ratio of 71/40 and mean age of （ 69.4±6.8 ） years, were enrolled. Glomerulonephritis was the first reason for ESRD （54.2 %）, while diabetic nephropathy was the second one （13.5 %）. The mean levels ofBP, Hb, iPTH, Alb were 142.3±16.2/77.7±8.2 mmHg, 107.9±17.2 g/l, 266.1 ±259.2 pg/mL, 34.5±4.9 g/L respectively. The qualified rates ofBP, iPTH and Kt/V were 39.6 %, 27.9% and 72.1%. In the high Hb level group, the incidence of DN was lower, and Scr and blood flow were higher. Conclusions Glomerulonephritis and diabetic nephropathy are the two main reasons for ESRD. Decreasing Hb levels are probably associated with worse nutritional status. Whether treatment of nutritional status may improve Hb level in elderly MHD patients is an important issue that deserves further research.