文章摘要
柴扬帆,林鸿波,丁国辉,王晋伟,王怀玉,彭苏元,高碧霞,邓心未,孔桂兰,包蓓艳,张路霞.基于区域医疗大数据的慢性肾脏病患者贫血患病及治疗情况调查[J].中华流行病学杂志,2023,44(7):1046-1053
基于区域医疗大数据的慢性肾脏病患者贫血患病及治疗情况调查
Prevalence and treatment of anemia in chronic kidney disease patients based on regional medical big data
收稿日期:2022-12-01  出版日期:2023-07-15
DOI:10.3760/cma.j.cn112338-20221201-01028
中文关键词: 慢性肾脏病  贫血  流行病学研究  电子健康档案
英文关键词: Chronic kidney disease  Anemia  Epidemiologic study  Electronic health record
基金项目:教育部人文社科基金(22YJA630036);北京市自然科学基金(7212201);浙江省自然科学基金(LZ22F020014);北京大学医学部-密歇根大学医学院转化医学与临床研究联合研究所项目(BMU2020JI011);北大百度基金(2020BD005,2019BD017)
作者单位E-mail
柴扬帆 北京大学公共卫生学院流行病与卫生统计学系, 北京 100191
北京大学健康医疗大数据国家研究院, 北京 100191 
 
林鸿波 宁波市鄞州区疾病预防控制中心, 宁波 315199  
丁国辉 沈阳航空航天大学计算机学院, 沈阳 110136  
王晋伟 北京大学第一医院肾内科, 北京 100034  
王怀玉 北京大学健康医疗大数据国家研究院, 北京 100191  
彭苏元 北京大学健康医疗大数据国家研究院, 北京 100191  
高碧霞 北京大学第一医院肾内科, 北京 100034  
邓心未 北京大学第一医院肾内科, 北京 100034  
孔桂兰 北京大学公共卫生学院流行病与卫生统计学系, 北京 100191
北京大学健康医疗大数据国家研究院, 北京 100191 
guilan.kong@hsc.pku.edu.cn 
包蓓艳 宁波市泌尿肾病医院, 宁波 315100 baobeiyan2007@sina.com 
张路霞 北京大学健康医疗大数据国家研究院, 北京 100191
北京大学第一医院肾内科, 北京 100034 
 
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中文摘要:
      目的 分析慢性肾脏病(CKD)患者的贫血患病率、影响因素及治疗情况。方法 采用描述性统计分析方法分析2012-2018年宁波市鄞州区域健康信息平台中CKD患者贫血患病情况及贫血患病后12个月内接受治疗的情况;采用多因素logistic回归模型分析CKD患者贫血患病的影响因素。结果 共纳入52 619例新发CKD患者,有15 639例(29.72%)CKD患者存在贫血,其中女性贫血患者10 178例(31.87%),男性贫血患者5 461例(26.41%),女性CKD患者贫血患病率高于男性,差异有统计学意义(P<0.001)。贫血患病率随着CKD分期的进展而增加(趋势检验P<0.001),由1期的24.77%增长至5期的69.42%。多因素logistic回归分析显示,CKD贫血患病主要的影响因素有性别(女性:aOR=1.57,95%CI:1.50~1.63)、CKD分期(2期:aOR=1.10,95%CI:1.04~1.16;3期:aOR=2.28,95%CI:2.12~2.44;4期:aOR=4.49,95%CI:3.79~5.32;5期:aOR=6.31,95%CI:4.74~8.39)、年龄(18~30岁:aOR=2.40,95%CI:2.24~2.57;61~75岁:aOR=1.35,95%CI:1.28~1.42;≥76岁:aOR=2.37,95%CI:2.20~2.55)、BMI(<18.5 kg/m2:aOR=1.29,95%CI:1.18~1.41;23.0~24.9 kg/m2:aOR=0.79,95%CI:0.75~0.83;≥25.0 kg/m2:aOR=0.70,95%CI:0.66~0.74)、腹型肥胖(aOR=0.91,95%CI:0.86~0.96)、慢性阻塞性肺疾病(aOR=1.15,95%CI:1.09~1.22)、恶性肿瘤(aOR=3.03,95%CI:2.84~3.23)、心力衰竭(aOR=1.44,95%CI:1.35~1.54)及心肌梗死(aOR=1.54,95%CI:1.16~2.04)。有12.03%的3~5期CKD贫血患者在12个月内接受了铁剂治疗,4.78%的患者接受了红细胞生成刺激剂(ESA)治疗。结论 宁波市鄞州区CKD患者贫血患病率较高,铁剂及ESA治疗率偏低,应加强CKD患者的贫血管理与治疗。
英文摘要:
      Objective To assess the prevalence, risk factors and treatment of anemia in patients with chronic kidney disease (CKD). Methods A descriptive method was used to analyze the prevalence and treatment of anemia in CKD patients based on regional health data in Yinzhou District of Ningbo during 2012-2018. The multivariate logistic regression analysis was used to identify independent influence factors of anemia in the CKD patients. Results In 52 619 CKD patients, 15 639 suffered from by anemia (29.72%), in whom 5 461 were men (26.41%) and 10 178 were women (31.87%), and anemia prevalence was higher in women than in men, the difference was significant (P<0.001). The prevalence of anemia increased with stage of CKD (24.77% in stage 1 vs. 69.42% in stage 5, trend χ2 test P<0.001). Multivariate logistic regression analysis revealed that being women (aOR=1.57, 95%CI:1.50-1.63), CKD stage (stage 2:aOR=1.10, 95%CI:1.04-1.16;stage 3:aOR=2.28,95%CI:2.12-2.44;stage 4:aOR=4.49,95%CI:3.79-5.32;stage 5:aOR=6.31,95%CI:4.74-8.39), age (18-30 years old: aOR=2.40,95%CI:2.24-2.57, 61-75 years old: aOR=1.35,95%CI:1.28-1.42, ≥ 76 years old: aOR=2.37,95%CI:2.20-2.55), BMI (<18.5 kg/m2:aOR=1.29,95%CI:1.18-1.41;23.0-24.9 kg/m2:aOR=0.79,95%CI:0.75-0.83; ≥ 25.0 kg/m2:aOR=0.70,95%CI:0.66-0.74), abdominal obesity (aOR=0.91, 95%CI:0.86-0.96), chronic obstructive pulmonary disease (aOR=1.15, 95%CI:1.09-1.22), cancer (aOR=3.03, 95%CI:2.84-3.23), heart failure (aOR=1.44, 95%CI:1.35-1.54) and myocardial infarction (aOR=1.54, 95%CI:1.16-2.04) were independent risk factors of anemia in CKD patients. Among stage 3-5 CKD patients with anemia, 12.03% received iron therapy, and 4.78% received treatment with erythropoiesis-stimulating agent (ESA) within 12 months after anemia was diagnosed. Conclusions The prevalence of anemia in CKD patients was high in Yinzhou. However, the treatment rate of iron therapy and ESA were low. More attention should be paid to the anemia management and treatment in CKD patients.
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