Clinical characteristics and risk assessment of chronic kidney disease in patients with thalassemia
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摘要: 目的 分析地中海贫血(简称地贫)与慢性肾病的相关性，并对地贫患者发生慢性肾病进行风险评估，为临床诊断提供参考依据。方法 收集2019年1月—2021年12月广东省人民医院肾内病区及门诊、妇产科与遗传优生门诊已检测地贫项目地贫慢性肾病、非地贫慢性肾病与地贫非慢性肾病患者共220例的信息资料及临床检验数据，并采用SPSS 22.0统计软件分析地贫与慢性肾病的相关性；地贫慢性肾病、非地贫慢性肾病与地贫非慢性肾病的指标分析。结果 地贫与慢性肾病间存在相关性，其是导致慢性肾病发生的独立影响因素(OR=1.75，P < 0.001)，地贫患者发生慢性肾病的风险性大于非地贫患者。地贫慢性肾病与非地贫慢性肾病患者的红细胞、血红蛋白、平均红细胞体积、铁蛋白比较，差异有统计学意义(P < 0.05)；地贫慢性肾病与地贫非慢性肾病的血红蛋白、白蛋白、尿素、肌酐等指标比较，差异有统计学意义(P < 0.05)。2种不同基因型α和β地贫患者发生慢性肾病的风险性差异无统计学意义(P>0.05)。结论 地贫患者可能是导致其慢性肾病发生的危险因素，其患慢性肾病的风险性较大，要定期监测患者各项相关指标，从而达到早防治的目的。Abstract: Objective To analyze the correlation between thalassemia and chronic nephropathy, and evaluate the risk of thalassemia patients with chronic nephropathy, so as to provide reference for clinical diagnosis.Methods The clinical data of 220 patients with chronic kidney disease of thalassemia, chronic kidney disease of non thalassemia and non chronic kidney disease of thalassemia who had been tested for thalassemia in nephrology and outpatient department, obstetrics and gynecology department and genetic prenatal outpatient department were collected from January 2019 to December 2021, and SPSS 22.0 was used for analysis.Results There was a correlation between thalassemia and chronic nephropathy, which was an independent factor leading to chronic nephropathy(OR=1.75, P < 0.001), and the risk of chronic nephropathy in thalassemia patients was greater than that in non-thalassemia patients. There were statistically significant differences in RBC, HGB, MCV, Ferr between patients with thalassemia chronic nephropathy and non-thalassemia chronic nephropathy(P < 0.05). HGB, ALB, Urea, CREA of thalassemia non-chronic nephropathy patients were significant than those of the control group(P < 0.05). There was no difference in the risk of chronic nephropathy patients between genotypes of α and β thalassemia(P>0.05).Conclusion Thalassaemia patients may be a risk factor for the occurrence of chronic nephropathy. Clinicians need to raise awareness and regularly monitor the relevant indicators of patients, so as to achieve the purpose of early prevention and treatment.
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Key words:
- thalassemia /
- chronic nephropathy /
- correlation /
- risk assessment /
- indicator anaysis
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表 1 地贫与慢性肾病的相关性分析
例 项目 非地贫 地贫 合计 r P 慢性肾病 50 90 140 -0.378 < 0.001 非慢性肾病 60 20 80 合计 110 110 220 
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表 2 α及β-地贫发生慢性肾病的风险分析
例 项目 α地贫 β地贫 合计 χ2 P 慢性肾病 53 37 90 0.008 0.927 非慢性肾病 12 8 20 合计 65 45 110
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表 3 地贫慢性肾病患者与非地贫慢性肾病患者的指标分析
项目 地贫慢性肾病患者(n=90) 非地贫慢性肾病患者(n=50) t/Z P TP/(g·L-1) 63.96±12.51 62.11±10.42 -0.887 0.376 ALB/(g·L-1) 32.89±8.77 31.30±7.24 -1.095 0.276 UA/(μmol·L-1) 485.51±151.03 472.80±158.31 -0.459 0.647 RBC/×(1012·L-1) 4.20±1.00 2.97±0.54 -8.001 < 0.001 Hb/(g·L-1) 90.56±18.70 83.78±14.23 -2.227 0.028 MCV/fl 69.53±7.23 87.27±6.63 14.322 < 0.001 MCH/pg 21.85±2.34 28.42±2.71 15.022 < 0.001 RDW-CV 0.18±0.04 0.16±0.03 -3.407 0.001 Ferr/(ng·mL-1) 250.3(127.3，488.0) 133.1(52.00，336.83) -2.260 0.024 Iron/(μmol·L-1) 9.57(5.95，15.65) 7.53(4.48，13.30) -2.014 0.044 ALT/(U·L-1) 14.50(10.00，22.50) 13.00(9.00，22.50) -1.990 0.047 AST/(U·L-1) 21.50(17.00，28.00) 18.00(12.00，23.00) -2.961 0.003 TBIL/(μmol·L-1) 6.95(5.30，8.85) 6.10(4.88，7.60) -2.351 0.019 TBA/(μmol·L-1) 5.10(3.00，8.30) 4.20(2.70，6.90) -1.566 0.117 MG/(mmol·L-1) 0.89(0.79，0.97) 0.84(0.74，0.95) -1.126 0.260 P/(mmol·L-1) 1.42(1.17，1.76) 1.63(1.32，1.91) -1.814 0.070 GLU/(mmol·L-1) 5.83(4.70，8.15) 5.62(4.81，7.85) -0.007 0.995 Urea/(mmol·L-1) 11.40(6.51，20.25) 17.25(11.33，23.83) -2.562 0.010 CR/(μmol·L-1) 190.17(88.57，618.99) 402.42(153.02，677.33) -1.829 0.067 Na/(mmol·L-1) 138.40(135.80，140.35) 137.70(135.58，139.50) -1.146 0.252
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表 4 地贫慢性肾病与地贫非慢性肾病患者的指标分析
项目 地贫慢性肾病患者(n=90) 地贫非慢性肾病患者(n=20) t/Z P Hb/(g·L-1) 90.56±18.70 114.50±17.77 5.224 < 0.001 TP/(g·L-1) 63.96±12.51 68.97±5.24 1.708 0.091 ALB/(g·L-1) 32.89±8.77 38.44±4.88 2.664 0.009 MG/(mmol·L-1) 0.89(0.79，0.97) 0.78(0.74，0.82) -2.855 0.004 P/(mmol·L-1) 1.42(1.17，1.76) 1.21(1.12，1.26) -2.976 0.003 GLU/(mmol·L-1) 5.83(4.70，8.15) 4.40(3.95，4.96) -4.301 < 0.001 Urea/(mmol·L-1) 11.40(6.51，20.25) 3.30(2.74，4.35) -6.382 < 0.001 Cr/(μmol·L-1) 190.17(88.57，618.99) 43.01(39.38，49.00) -5.807 < 0.001 UA/(μmol·L-1) 485.51±151.03 335.17±105.26 -0.412 < 0.001 Na/(mmol·L-1) 138.40(135.80，140.35) 137.00(135.90，138.08) -1.846 0.065 TBA/(μmol·L-1) 5.10(3.00，8.30) 2.60(1.80，3.50) -3.551 < 0.001
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