Analysis of anemia occurrence and its influencing factors among physical examination population
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摘要: 目的 调查桂林市体检人群贫血发生状况，探讨其与常见慢性病的相互影响。方法 收集2019年中国人民解放军联勤保障部队第九二四医院健康医学科开展包含血常规、肝功、肾功、血糖、血脂等项目检测的桂林市38 948例健康体检资料，采用SPSS 17.0软件进行横断面筛查统计分析，P< 0.05为差异有统计学意义。结果 桂林市健康体检人群贫血患病率为6.7%，其中60岁以上患病率最高(10.41%)且以男性为主，患病率为13.60%，但男性总体贫血率显著低于女性(5.24% vs 8.69%，P< 0.01)。贫血人群中轻度贫血占94.9%，主要为男性，中度贫血占4.9%，以女性为主，重度贫血占0.19%。按细胞形态分类，贫血人群以小细胞低色素性贫血为主，占33.95%，其中女性显著高于男性(37.42% vs 29.7%，P< 0.01)。本次调查体检人群患高血脂和高血压(HUA)人群最多，分别占41.93%、24.38%，且男性慢性病患病率均显著高于女性(P< 0.01)。贫血人群中仅患慢性肾病(CKD)风险较正常人群明显上升(5.29% vs 1.36%，P< 0.01)，但贫血男性相较贫血女性人群患高尿酸(HNT)、高血糖和CKD风险明显升高(24.43% vs 7.46%，12.26% vs 3.41%，9.53% vs 1.81%，P< 0.01)。通过logistic回归分析慢性病对贫血患者的影响，结果显示高龄、尿素升高和高肌酐水平可增加贫血风险(P< 0.01)。结论 桂林市居民贫血是老年人群特别是老年男性人群常见的健康问题。贫血可显著增加慢性肾脏病患病风险，贫血人群特别是在男性贫血人群中更应重视慢性病筛查和早期预防，控制慢性病相关风险因素。Abstract: Objective To investigate the occurrence of anemia in the physical examination population in Guilin, and explore its interaction with chronic disease.Methods To collect the health examination data of Guilin residents(n=38 948) who had conducted health examination in our department in 2019, the data was conducted by cross-sectional screening analysis with SPSS 17.0 software,P< 0.05 means the difference was statistically significant.Results The prevalence of anemia in the health examination population in Guilin was 6.7%, the prevalence rate of the most people was over 60 years old(10.41%), and the prevalence rate was 13.60% in males, but the overall anemia rate in males was significantly lower than that in females(5.24% vs 8.69%,P< 0.01). The mild anemia accounted for 94.9%, and the large number was male. The moderate anemia accounted for 4.9%, most was female, and the severe anemia of the anemia population accounted for 0.19%. The anemia population mainly was small cell hypochromic anemia classified by cell morphology, accounting for 33.95%. Small cell hypochromic anemia in female was significantly higher than that in male(37.42% vs 29.7%,P< 0.01). In this survey, the mainly diseases were hyperlipidemia and HUA in the physical examination population, which respectively accounted for 41.93% and 24.38%, the prevalence of all metabolic disease in men was significantly higher than that in women(P< 0.01). It found that only the risk of CKD in anemia population was significantly higher than that in normal population(5.29% vs 1.36%,P< 0.01). However, men with anemia had significantly higher risks of HNT, hyperglycemia and CKD than women(24.43% vs 7.46%, 12.26% vs 3.41%, 9.53% vs 1.81%,P< 0.01). To analyze the impact of metabolic diseases on the prevalence of anemia through Logistic regression, the results showed that advanced age, elevated urea and high creatinine could increase the risk of anemia(P< 0.01).Conclusion The prevalence anemia of urban residents in Guilin was still a common health problem for the elderly people, especially in men. Anemia could significantly increase the risk of CKD, and the anemia people especially in the male population should pay more attention to chronic disease screening and prevention, and control the chronic disease related risk factors.
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Key words:
- anemia /
- chronic disease /
- prevalence /
- influencing factors
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表 1 体检人群贫血患病率及各年龄段分布
%(例/例) 性别 例数 贫血例数 < 30岁 30~60岁 >60岁 χ2 P 男 22 442 1175 2.87(111/3868) 4.19(651/15 536) 13.60(413/3038) 373.998 < 0.01 女 16 506 1435 6.62(192/2901) 9.75(1124/11 531) 5.74(119/2074) 1 312.877 < 0.01 合计 38 948 2610 4.48(303/6769) 6.56(1775/27 067) 10.41(532/5111) 1 442.251 < 0.01 
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表 2 贫血人群贫血程度分级及细胞形态学分型情况
例(%) 性别 例数 Hb贫血程度分级 MCV、MCH、MCHC细胞形态学分型 轻度 中度 重度 大细胞性贫血 正常细胞性贫血 小细胞低色素性贫血 单纯小细胞性贫血 男 1175 1154(98.21) 18(1.53) 3(0.26) 16(1.36) 325(27.66) 349(29.70) 364(30.98) 女 1435 1323(92.20) 110(7.67) 2(0.14) 2(0.14) 284(19.79) 537(37.42) 386(26.90) 合计 2610 2477(94.90) 128(4.90) 5(0.19) 18(0.69) 609(23.33) 886(33.95) 750(28.74) χ2 11.530 66.125 0.200 10.889 2.760 39.892 0.645 P < 0.01 < 0.01 >0.05 < 0.01 >0.05 < 0.01 >0.05
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表 3 贫血组与非贫血组患常见慢性病风险比较
例(%) 组别 检查人数 HNT 高血糖 血脂异常 HUA CKD 男 贫血组 1175 287(24.43) 144(12.26) 420(35.74) 374(31.83) 112(9.53) 非贫血组 21 267 4057(19.08) 2220(10.44) 10 614(49.91) 6786(31.91) 402(1.89) 女 贫血组 1435 107(7.46) 49(3.41) 310(21.60) 143(9.97) 26(1.81) 非贫血组 15 071 1647(10.93) 896(5.95) 4986(33.08) 2194(14.56) 93(0.62) 合计 贫血组 2610 394(15.10) 193(7.39) 730(27.97) 517(19.81) 138(5.29) 非贫血组 36 338 5704(15.70) 3116(8.58) 15 600(42.93) 8980(24.71) 495(1.36)
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表 4 贫血与非贫血人群慢性病风险指标比较
X±S 贫血组(n=2610) 非贫血组(n=36 338) 年龄/岁 46.93±15.71 42.92±13.562) BMI/(kg·m-2) 23.15±3.24 24.07±3.352) SBP/mmHg 119.86±18.90 120.62±17.461) DBP/mmHg 72.94±10.60 75.84±11.332) FPG/(mmol·L-1) 5.00±1.29 5.15±1.312) SUA/(μmol·L-1) 335.29±99.98 360.01±90.692) TC/(mmol·L-1) 4.74±1.16 5.17±1.032) TG/(mmol·L-1) 1.35±2.13 1.71±1.802) LDL-C/(mmol·L-1) 2.55±0.77 2.91±0.802) BUN/(mmol·L-1) 4.84±2.33 4.65±1.192) Cr/(μmol·L-1) 78.17±66.97 74.99±16.702) 与贫血组比较，1)P < 0.05，2)P < 0.01。
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表 5 贫血影响因素logistic相关性分析
因素 参照 β SE Wald χ2 P OR 95%CI 年龄 高龄 低龄 0.034 0.002 449.301 < 0.01 1.035 1.031~1.038 BMI 高水平 低水平 -0.051 0.008 43.245 < 0.01 0.950 0.936~0.965 SBP 高水平 低水平 -0.003 0.001 6.632 < 0.01 0.997 0.994~0.999 DBP 高水平 低水平 -0.027 0.002 157.123 < 0.01 0.973 0.969~0.978 FPG 高水平 低水平 -0.177 0.025 51.424 < 0.01 0.838 0.799~0.880 TC 高水平 低水平 -0.263 0.060 19.505 < 0.01 0.768 0.684~0.864 TG 高水平 低水平 -0.656 0.053 154.397 < 0.01 0.519 0.468~0.575 LDL-C 高水平 低水平 -0.314 0.076 17.072 < 0.01 0.731 0.630~0.848 SUA 高水平 低水平 -0.002 0.000 47.861 < 0.01 0.998 0.997~0.999 BUN 高水平 低水平 0.072 0.014 25.014 < 0.01 1.074 1.044~1.105 Cr 高水平 低水平 0.005 0.001 31.112 < 0.01 1.005 1.003~1.006 常量 2.514 0.296 72.175 < 0.01 12.348
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