【摘要】目的 评估老年终末期肾病(end-stage renal disease，ESRD)患者血液透析(hemodialysis, HD)治疗的质量及影响因素。方法选取2018年7月～2020年2月兰州大学第二医院肾病内科血液透析中心年龄≥60岁启动HD的资料完整的患者共76例，进行治疗前后资料的收集。结果 兰州大学第二医院肾病内科血液透析中心老年ESRD患者启动HD时共病患病率达50%，估算肾小球滤过率(estimated glomerular filtration rate,eGFR)均值(5.71±3.23)ml/(min·1.73m2)，专科干预后血红蛋白 (hemoglobin,Hb)、血钙(serum calcium, Ca)、血磷(serum phosphate,P)、血清白蛋白(serum albumin, ALB)的控制率均提高(χ2分别为6.930、8.528、7.617、14.729, P 值分别为0.014、0.006、0.009、＜0.001)，全段甲状旁腺激素(intact parathyroid hormone,iPTH) 高水平组患者的比例减少(χ2=6.233, P=0.019)。Hb. Ca. P. ALB. iPTH控制组及非控制组组间比较时，启动透析时eGFR水平(Z值分别为-1.841、-1.128、-0.153、 -1.629、- 0.402，P 值分别为0.066、0.259、0.878、0.103、0.687)、性别(χ2 值分别为1.690、0.472、0.471、0.091、0.169，P 值分别为0.194、0.492、0.493、0.763、0.681)、病程(t/Z 值分别为-0.944、-1.868、1.036、-0.223、-1.047，P 值分别为0.345、0.062、0.306、0.823、0.295)血管通路(χ2值分别为0.056、0.153、0.091、2.487、0.329，P 值分别为0.812、0.696、0.763、0.115、0.566)、透析龄(Z 值分别为-0.040、-1.798、-0.456、-0.008、-0.914，P 值分别为0.966、0.072、0.648、0.994、0.361)、透析模式(χ2分别为1.749、0.220、0.248、1.513、0.003，P 值分别为0.186、0.639、0.619、0.219、0.958)均无统计学差异。结论老年ESRD 患者的HD 时机可适度延迟，加强后期个体化治疗及积极有效管理，提高各指标控制率。
【Abstract】Objective To investigate the hemodialysis quality of elderly patients with end- stage renal disease (ESRD) and the relevant factors. Methods We included patients who started hemodialysis after 60 years of age at the Lanzhou University Second Hospital's Hemodialysis Center from July 2018 to February 2020. A total of 76 patients with complete data and their pre-dialysis and post-dialysis clinical data were collected. Results Elderly ESRD patients with comorbidities can reach as high as 50%, with the average estimated glomerular filtration rate (eGFR) level of (5.71±3.23)ml/(min·1.73m2) when starting hemodialysis treatment.
After treatment, the control rates of hemoglobin(Hb) (χ2=6.930, P=0.014), serum calcium (Ca) (χ2= 8.528，P=0.006), serum phosphate (P) (χ2=7.617, P=0.009), serum albumin (Alb) (χ2=14.729, P<0.001) were increased, and the rate of high intact parathyroid hormone (iPTH) is lower (χ2=6.233，P=0.019). According to the level of Hb, Ca, P, Alb, patients were divided into the standard group and the non-standard group. There was no significant difference in the eGFR level o (Z were -1.841, -1.128, -0.153, -1.629, -0.402, P values were 0.066, 0.259, 0.878, 0.103, 0.687, respectively), gender (χ2 were 1.690, 0.472, 0.471, 0.091, 0.169, P values were 0.194, 0.492, 0.493, 0.763, 0.681, respectively), course (t/Z were -0.944, -1.868, 1.036, -0.223, -1.047, P values were 0.345, 0.062, 0.306, 0.823, 0.295, respectively), vascular access (χ2 were 0.056, 0.153, 0.091, 2.487, 0.329, P values were 0.812, 0.696, 0.763, 0.115, 0.566, respectively), dialysis vintage (Z were -0.040, -1.798, -0.456, -0.008, -0.914, P values were 0.966, 0.072, 0.648, 0.994, 0.361) and hemodialysis methods (χ2 were 1.749, 0.220, 0.248, 1.513, 0.003, P values were 0.186, 0.639, 0.619, 0.219, 0.958, respectively) between two groups. Conclusion By strengthening late-stage individualized treatment and active and effective management of comorbidities, and improving the standard rate of clinical indicators, the timing of HD in elderly ESRD patients can be appropriately delayed.
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