【摘要】目的分析估算肾小球滤过率(estimated glomerular filtration rate，eGFR)及基于模糊数学的透析时机评价方程(dialysis initiation based on fuzzy mathemaitcs equation，DIFE)对血液透析时机评估方法与维持性血液透析患者生存预后的相关性。方法分别依据eGFR 及DIFE 值将252例维持性血液透析患者分为早透析、适宜透析及晚透析组，并比较开始透析时各组的临床指标，分析其与患者生存预后的关系。结果2 种评估方法下早透析、适宜透析及晚透析组患者整体生存时间差异无统计学意义(χ2=4.059、1.162，P=0.131、0.559)；年龄(HR=1.041，95% CI 1.022～1.060，P＜0.001)、原发病为原发肾小球病(HR=0.378，95% CI 0.219～0.653，P＜0.001)或糖尿病肾病(HR=2.092，95% CI 1.250～3.498，P=0.005)、合并症≥3 种(HR=2.591，95% CI 1.457～4.606，P=0.001)是影响患者生存预后的因素；分别将eGFR、DIFE 分组赋值加入COX 多因素分析显示：年龄是影响患者生存预后的独立危险因素(HR=1.035、1.043，95% CI 分别为1.013～1.057、1.020～1.067，P=0.001、＜0.001)，原发病为原发肾小球病是保护因素(HR=0.465、0.502，95% CI 分别为0.246～0.877、0.267～0.943，P=0.018、0.032)。结论采用eGFR 及DIFE 评估血液透析时机，均对患者整体生存时间无显著影响，将部分指标量化并赋予不同权重后纳入透析时机评价体系是合理的。
【Abstract】Objective To analyze the correlation between the hemodialysis initiation timing assessment using estimated glomerular filtration rate (eGFR) or dialysis initiation based on fuzzy mathematics equation (DIFE) and survival prognosis in patients undergoing maintenance hemodialysis (MHD). Methods A total of 252 MHD patients were divided into early dialysis group, suitable dialysis group and late dialysis group based on eGFR or DIFE assessment method. Their clinical indicators at the beginning of dialysis were compared among the groups, and the relationship between the clinical indicators and survival prognosis was analyzed. Results There were no significant differences in overall survival time among early dialysis group, suitable dialysis group and late dialysis group divided using either eGFR value or DIFE value (χ2=4.059 and 1.162 respectively, P=0.131 and 0.559 respectively). Age (HR=1.041, 95% CI 1.022～1.060, P<0.001), primary etiology of primary glomerulopathy (HR=0.378, 95% CI 0.219～0.653, P<0.001) or diabetic nephropathy (HR=2.092, 95% CI 1.250～3.498, P=0.005), and more than 3 comorbidities (HR=2.591, 95% CI 1.457～4.606, P=0.001) were the factors influencing survival prognosis of the patients. COX multivariate analysis showed that age was an independent risk factor for survival prognosis of the patients divided using either eGFR or DIFE (HR=1.035 and 1.043, respectively; 95% CI 1.013～1.057 and 1.020～1.067, respectively; P=0.001 and <0.001, respectively), and primary etiology of glomerular disease was a protective factor (HR=0.465 and 0.502, respectively; 95% CI 0.246～0.877 and 0.267～0.943, respectively; P=0.018 and 0.032, respectively). Conclusion Hemodialysis initiation time assessment using either eGFR or DIFE has no significant effect on the overall survival prognosis of the patients. It is reasonable to include several indexes into the assessment system of hemodialysis initiation timing after quantifying and assigning their different weights.
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