影响血液透析患者长期生存率的相关因素分析

武晴文; 李静; 李荣山; 王利华

doi:10.3969/j.issn.1671-4091.2019.08.008

中国血液净化 >

2019 , Vol. 18 >Issue 08: 543 - 546

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.08.008

临床研究

影响血液透析患者长期生存率的相关因素分析

武晴文 ,
李静 ,
李荣山 ,
王利华

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1山西医科大学第二医院肾内科
2山西省人民医院、山西肾脏病研究所
3山西省卫生健康委医疗质量控制管理中心，血液净化质量控制中心

收稿日期: 2019-02-18

修回日期: 2019-04-09

网络出版日期: 2019-08-15

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Analysis of related factors affecting long- term survival of hemodialysis patients

WU Qing-Wen ,
LI Jing ,
LI Rong-Shan ,
WANG Li-Hua

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1Department of Nephrology, Second Hospital of Shanxi MedicalUniversity, Taiyuan 030001, China
2Shanxi Provincial People's Hospital & Shanxi Institute of Nephrology,Taiyuan 030001, China
3Medical Quality Control Management Center & Blood Purification Quality Control Center, Shanxi Provincial Health and Family Planning Commission, Taiyuan 030001, China

Received date: 2019-02-18

Revised date: 2019-04-09

Online published: 2019-08-15

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摘要

【摘要】目的分析影响维持性血液透析(maintenance hemodialysis，MHD)患者长期生存率的相关危险因素。方法对山西省2013 年血液净化病例登记系统中登记的1597 例行MHD 3 个月以上的患者进行随访研究，统计分析以下参数：①基线指标：性别、年龄(进入透析时的年龄)、透析龄、血管通路类型、透析器种类、抗凝剂；②原发病分布、治疗转归及死亡原因；③临床及实验室检查指标：透析前血压、尿素氮下降率(urea reduction rate,URR)、尿素清除指数(SpKt/V)、血红蛋白(hemoglobin，Hb)、钙(calcium，Ca)、磷(phosphorus，P)、血清白蛋白(blood albumin，Alb)。结果①原发性肾小球疾病(53.2%)为最主要的原发病，糖尿病肾病患者≥50 岁较＜50 岁(31.5%比7.4%)比例明显升高(χ2=160.520,P＜0.001)；② 首位死亡原因为心血管事件(42.19%)，其次为脑血管事件(25.78%)和感染(10.94%)；③原发性肾小球疾病(RR=0.532,95% CI：0.366～0.772，P=0.001)、Hb≥100g/L (RR= 0.510, 95%CI：0.374～0.696，P＜0.001)、Alb≥35g/L(RR=0.355,95% CI：0.266～0.472，P＜0.001)，透析前血压≤140/90 mmHg (1mmHg=0.133kpa)(RR=0.689,95% CI：0.496～0.957，P=0.026)为结局的保护性因素。结论心血管事件为首位死亡原因，＞50 岁MHD 患者糖尿病肾病比例明显升高，原发病类型、贫血、低蛋白血症、透析前血压可影响MHD 患者长期生存率。

关键词： 血液透析; 危险因素; 生存分析

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武晴文 , 李静 , 李荣山 , 王利华 . 影响血液透析患者长期生存率的相关因素分析[J]. 中国血液净化, 2019 , 18(08) : 543 -546 . DOI: 10.3969/j.issn.1671-4091.2019.08.008

Abstract

【Abstract】Objective To analyze the potential risk factors that influence the survival of maintenance hemodialysis (MHD) patients. Methods A follow-up study was conducted on 1,597 patients undergoing MHD for more than 3 months and registered in the Registration System of Blood Purification Cases (CNRDS) in 2013. The following parameters were analyzed: ① baseline data including gender, age, age of dialysis, type of vascular access, type of dialyzer and anticoagulant; ②distribution of primary disease, treatment outcome and cause of death; ③clinical and laboratory examination results including pre-dialysis blood pressure, urea reduction rate (URR), urea clearance index (spKt/V), hemoglobin, calcium, phosphate and albumin. Results

①The most common primary disease was primary glomerular disease (53.2%). The proportion of diabetic nephropathy patients were significantly higher in patients ≤50 years old than in those < 50 years old (31.5% vs. 7.4%, χ2=160.520, P＜0.001). ②The first cause of death was cardiovascular events (42.19%), followed by cerebrovascular events (25.78%) and infection (10.94%). ③Primary glomerular disease (RR=0.532, 95% CI 0.366～0.772, P=0.001), Hb ≥100g/L (RR=0.510, 95% CI 0.373～0.696, P<0.001), Alb ≥35g/L (RR=0.355, 95% CI 0.266～0.472, P＜0.001), and pre- dialysis blood pressure ≤ 140/90 mmHg (RR=0.689, 95% CI 0.496～0.957, P=0.026) were the protective factors for outcome. Conclusion Cardiovascular events were the leading cause of death in MHD patients. The proportion of diabetic nephropathy is significantly increased in MHD patients over 50 years old. Primary disease type, anemia, hypoproteinemia, and pre-dialysis hypertension can affect the long-term survival of MHD patients.

Key words： Hemodialysis; Risk factors; Survival analysis

参考文献

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