Objective To analyze anemia influencing factors of children with chronic peritoneal dialysis. Methods A retrospective review of 32 patients with registration of chronic peritoneal dialysis was carried out at Childrenˊs Hospital of Fudan University from January 2006 to April 2012,the follow-up files after dialysis were established,once follow-up was taken every three months in our hospital,duration of follow-up was 12 months at least,follow-up indicators were examined. Baseline follow-up indicators of pre-dialysis were shown by the number of cases,after dialysis the follow-up indicators( medical projects,laboratory projects and infection)were showed by episodes,hemoglobin value of every three months follow-up time ± 3 days was selected to diagnose anemia. If patients met the diagnostic criteria of anemia,this stage of follow-up indicators were included in the anemia group,whereas if the patients did not meet were included in the non-anemic group. SpSS 19. 0 software was applied for statistical analysis,the measurement data were compared using Studentˊs t-test,frequency distributions were compared using the chi-square test,multivariate logistic regression analysis was used to identify factors associated with anemia. Results (1)30/32(93. 75%) patients met the criteria for anemia at the baseline,57/120(47. 5%)episodes still met the criteria for anemia after following up 12 months. Hemoglobin and hematocrit in the anemia group were significantly lower than those in the non-anemic group. ( 2 )Univariate analysis showed that:①peritoneal dialysis age and sex did not significantly differ( P >0. 05 ). ②There were no siginificant differences in BMI,systolic pressure or diastolic pressure between the anemia group and the non-anemic group( P>0. 05).③Serum parathyroid hormone(pTH)levels in the anemia group were higher than that in the non-anemic group[(605 ± 582)vs(386 ± 434)pg·mL-1 ],pTH levels between 500 and 1 000 pg·mL-1 was associated with higher incidence of anemia than pTH levels below 500 pg·mL-1 . Residual renal Kt/V in the anemia group was lower than that in the non-anemic group[(0. 35 ± 0. 42 )vs( 0. 62 ± 0. 63 ),P <0. 05 ],incidence of left ventricular hypertrophy was higher than that in the non-anemic group (62. 5% vs 35. 1%,χ2 =5. 758,P=0. 016). In the anemia group,serum albumin,total Kt/V,total CrCL and residual renal CrCL were lower than those in the non-anemic group(P>0. 05),blood urea nitrogen and serum creatinine were higher than those in the non-anemic group(P>0. 05),the differences were not statistically significant. ④There was no siginificant difference in prescibed ACEI between the anemia group and the non-anemic group(P> 0. 05). ⑤In the anemia group ,elemental iron dose and EpO dose were lower than those in the non-anemic group[(3. 5 ± 1. 9)vs(4. 2 ± 1. 2)mg·kg-1 ·d-1 ,(134 ± 66)vs(170 ± 62)U·kg-1 per week,P<0. 05]. ⑥The incidence of anemia in patients with infection was higher than patients without infection(35. 1% vs 19. 0%,P<0. 05).(3)Multivariate logistic regression analysis showed that serum ipTH levels,residual renal Kt/V and infection were associated with anemia in chronic pD children( P<0. 05). Conclusion ①In peritoneal dialysis children,the serum ipTH levels,residual renal Kt/V and infection were associated with anemia. ②Erythropoietin and iron to individualized treatment should be emphasized,in the high levels of serum ipTH,infection,and other circumstances,it may require higher doses of erythropoietin and iron improve anemia;③ It is important to pay more attention to the early treatment of renal anemia and management of CKD children.%目的：了解终末期肾病慢性腹膜透析（腹透）患儿贫血的影响因素。方法回顾性分析2006年1月至2012年4月在复旦大学附属儿科医院（我院）肾脏风湿科登记并行长期规律腹透治疗患儿，腹透后建立随访档案，要求每3个月来我院随访1次，至少随访12个月，并行随访指标的检查。腹透开始前的基线随访指标以例数表现，腹透后随访指标中的计量计数指标（体检项目、实验室检查项目和感染情况）以例次表现，选取每3个月随访时间±3 d时Hb值判断贫血，如符合贫血诊断标准则该阶段随访指标纳入贫血组统计，反之纳入非贫血组统计。单因素分析采用独立样本t检验，计数资料采用χ2检验，多因素分析采用Logistic回归分析。结果（1）符合本文纳入排除标准的32例患儿进入分析，开始腹透年龄（8.4±3.7）岁，开始腹透前30例（93.8%）存在贫血；开始腹透后共随访120例次，8例次失访，贫血组57例次（47.5%），非贫血组63例次，贫血组Hb、红细胞压积均明显低于非贫血组。（2）单因素分析显示：①基本情况：贫血组与非贫血组相比，腹透时年龄、性别差异无统计学意义（P>0.05）；②体检项目：BMI、收缩压、舒张压两组差异无统计学意义（P>0.05）；③实验室检查项目：随访12个月，贫血组血清全段甲状旁腺激素（ipTH）水平高于非贫血组[（605±582）vs（386±434） pg·mL-1，P<0.05]，血清ipTH在500~1000 pg·mL-1患儿贫血的发生率显著高于ipTH<500 pg·mL-1者（P<0.05）；贫血组残肾Kt/V值低于非贫血组[（0.35±0.42）vs（0.62±0.63），P<0.05]，左心肥厚的发生率高于非贫血组（62.5% vs 35.1%，χ2=5.758，P=0.016）；贫血组血清白蛋白、总Kt/V、总CrCL、残肾CrCL均低于非贫血组（ P>0.05），血尿素氮、肌酐均高于非贫血组（P>0.05）；④ACEI使用率贫血组与非贫血组间差异无统计学意义（P>0.05）；⑤贫血组元素铁剂量、促红细胞生成素（EpO）剂量均低于非贫血组[元素铁剂量：（3.5±1.9）vs（4.2±1.2）mg·kg-1·d-1；EpO：每周（134±66）vs（170±62）U·kg-1，P<0.05]；⑥感染发生率贫血组高于非贫血组（35.1% vs 19.0%，P<0.05）；（3）多元回归分析显示，血清ipTH水平、残肾Kt/V、感染与慢性腹透患儿的贫血具有相关性（ P<0.05）。结论①慢性腹透患儿血清ipTH水平、有无感染和残肾Kt/V与贫血具有相关性；②强调EpO、铁剂的个体化治疗，在高血清ipTH水平、感染等情况下，可能需要更大剂量的EpO、铁剂改善贫血；③应加强对慢性肾脏病患儿管理，重视肾性贫血的早期治疗。
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