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目的血液透析患者贫血相关治疗管理目前存在很大的挑战性,探讨是否能通过经计算机决策支持(CDS)系统制定促红细胞生成素使用剂量对改善肾性贫血有帮助。方法选择2013年10月至2014年4月吉林大学第二医院血液透析中心给予促红素治疗持续3个月慢性肾脏病5期的患者564例,其中男性296例,女性268例;年龄22~83岁,平均年龄43.21岁。将患者分为人工组及CDS组,人工组493例,CDS组71例。依据患者干体质量、红细胞压积变化调整促红细胞生成素剂量,监测并观察患者血红蛋白变化,统计两组数据并做统计学分析。结果两组患者年龄主要集中在中年组(45~59岁)。终末期肾病病因主要是糖尿病肾病。两组患者贫血相关生物化学指标变化稳定,无明显差异。经调整中心和基线差异后每周平均促红细胞生成素剂量CDS组比人工组减少4%(率比0.96;95%可信区间0.77~1.18),差异无统计学意义(P>0.05)。两组监测的血红蛋白变化幅度很相似(σ2=1.30)。分析两组血红蛋白值调整比值比和未调整比值比,得出人工组平均血红蛋白值为118 g/L(标准误2 g/L),比CDS组低1.1 g/L(标准误0.4 g/L)(P<0.001)。在调整两组基线特征的差异后,CDS组比人工组平均血红蛋白值低1.4 g/L(标准误0.5 g/L)。分析线性混合模型得出:CDS组所达到的血红蛋白值中有向100~120 g/L和110~120 g/L增长的趋势,促红细胞生成素使用剂量CDS组比人工组减少4%,差异无统计学意义(P>0.05)。结论两种促红细胞生成素给药方式对比,两组患者每月血红蛋白值在100~120 g/L波动,治疗效果无明显差别,但CDS组促红细胞生成素总剂量较人工组少。
Aims At present, the management of anemia-related therapies in hemodialysis patients presents a great challenge to explore whether it is helpful to improve the renal anemia through the use of dosages of erythropoietin by computerized decision support system (CDS). Methods From October 2013 to April 2014, 564 patients with chronic kidney disease and 5 patients with chronic kidney disease were enrolled in the hemodialysis center of the Second Hospital of Jilin University from January 1992 to April 2014. There were 296 males and 268 females, aged 22 ~ 83 years old, average age 43.21 years old. Patients were divided into artificial group and CDS group, 493 cases of artificial group, 71 cases of CDS group. The dosage of erythropoietin was adjusted according to the dry weight and hematocrit of the patients, the changes of hemoglobin in patients were monitored and observed, and the data of two groups were statistically analyzed. Results The age of the two groups mainly concentrated in the middle-aged group (45 to 59 years). The main cause of end-stage renal disease is diabetic nephropathy. Anemia-related biochemical indicators of stable change in both groups, no significant difference. After adjusted for baseline and baseline differences, the mean weekly erythropoietin dose in the CDS group was 4% less than in the manual group (odds ratio 0.96; 95% confidence interval 0.77 to 1.18), with no significant difference (P> 0.05). The magnitude of change in hemoglobin monitored by both groups was similar (σ2 = 1.30). The average hemoglobin value of the artificial group was 118 g / L (standard error 2 g / L), 1.1 g / L lower than that of the CDS group (standard error 0.4 g / L ) (P <0.001). After adjusting for differences in baseline characteristics between the two groups, the CDS group was 1.4 g / L (standard error 0.5 g / L) lower than the mean hemoglobin value of the artificial group. The results of linear mixed model analysis showed that the hemoglobin values in the CDS group increased from 100 to 120 g / L and from 110 to 120 g / L, and the dosage of erythropoietin in the CDS group decreased by 4% No statistical significance (P> 0.05). Conclusions The comparison of the administration modes of two erythropoietin, the monthly hemoglobin value fluctuated between 100 and 120 g / L in two groups showed no significant difference. However, the total dose of erythropoietin in the CDS group was less than that of the artificial group.