Department of Gastroenterology, Ishikiri Seiki Hospital, Higashi-Osaka, Osaka, Japan.
Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan.
Digestion. 2020;101(6):730-736. doi: 10.1159/000502228. Epub 2019 Aug 16.
The number of patients on chronic dialysis in Japan is increasing every year, and the average age of these patients is also increasing annually. Iron deficiency is an important cause of anemia in patients on hemodialysis (HD). However, it has not been clarified whether these patients might have small intestinal mucosal lesions causing iron deficiency anemia.
We conducted a cross-sectional study in -asymptomatic patients on HD between April 2014 and -December 2015. We performed small bowel capsule endoscopy (SBCE) and analyzed the relationship between small intestinal endoscopic findings and anemia.
SBCE was successfully completed in 39 eligible patients. Univariate analysis revealed that there was a significant difference in blood hemoglobin levels between the morbid SBCE-finding group (median 7.7 g/dL; range 6.7-9.2 g/dL) and the non-morbid SBCE-finding group (median 10.65 g/dL; range 6.4-13.1 g/dL; p = 0.0006, Mann-Whitney U test). On multivariate analysis, the blood hemoglobin level was an independent predictor of morbid SBCE findings (p = 0.0033). The cutoff value of blood hemoglobin level for the morbid SBCE finding was determined as 9.2 g/dL using receiver operating characteristic curve analysis.
Patients on HD with anemia are at a high risk of small intestinal lesions. Since the control of small intestinal lesion may improve the anemia, these outcomes are significant factors for managing patients on HD.
日本慢性透析患者人数逐年增加，这些患者的平均年龄也逐年增加。铁缺乏是血液透析（HD）患者贫血的重要原因。然而，尚未明确这些患者是否可能存在导致缺铁性贫血的小肠黏膜病变。
我们在 2014 年 4 月至 2015 年 12 月期间对无症状 HD 患者进行了一项横断面研究。我们进行了小肠胶囊内镜（SBCE）检查，并分析了小肠内镜检查结果与贫血之间的关系。
39 名符合条件的患者成功完成了 SBCE。单因素分析显示，病态 SBCE 发现组（中位数 7.7 g/dL；范围 6.7-9.2 g/dL）和非病态 SBCE 发现组（中位数 10.65 g/dL；范围 6.4-13.1 g/dL）的血液血红蛋白水平存在显著差异（p = 0.0006，Mann-Whitney U 检验）。多因素分析显示，血液血红蛋白水平是病态 SBCE 发现的独立预测因子（p = 0.0033）。使用受试者工作特征曲线分析确定血液血红蛋白水平的病态 SBCE 发现截断值为 9.2 g/dL。
患有贫血的 HD 患者小肠病变的风险较高。由于控制小肠病变可能改善贫血，因此这些结果是管理 HD 患者的重要因素。
