目的 探讨高龄维持性血液透析(maintenance hemodialysis,MHD)患者死亡的危险因素，为改善透析患者预后、降低死亡率提供参考。 方法 收集多中心的高龄(年龄≥80岁)MHD患者相关资料进行回顾性分析，按死亡与否分为死亡组及对照组。采用单因素分析及Logistic回归模型分析死亡相关危险因素。 结果 共纳入高龄MHD患者112例，其中死亡26例(23.214%)；首位死亡原因为心血管事件[9例(34.615%)]。2组患者血管通路类型(χ2=4.825，P=0.028)、原发疾病(F=24.243，P=0.004)、白细胞计数(t=-4.869，P＜0.001)、淋巴细胞计数(t=3.400，P＜0.001)、嗜酸性粒细胞计数(t=2.895，P=0.005)、白蛋白(t=3.089，P=00.003)、前白蛋白(t=3.247，P=0.002)、总胆固醇(t=2.037，P=0.044)、胆碱酯酶 (t=2.595，P=0.011)等比较差异有统计学意义。多因素Logistic回归分析提示：糖尿病肾病(OR=67.196，95% CI：5.034～896.973，P=0.001)、高血压肾损害(OR=15.577，95% CI：1.765～137.477， P=0.013)、高水平白细胞计数(OR=1.661，95% CI：1.117～2.469，P=0.012)为高龄MHD患者死亡的独立危险因素；高水平淋巴细胞(＞3.556×1012/L)(OR=0.120，95% CI：0.014～0.986，P=0.049)为高龄MHD患者死亡的保护因素。 结论 高龄MHD患者主要死亡原因为心血管事件；糖尿病肾病、高血压肾损害、白细胞计数及淋巴细胞计数是高龄MHD患者死亡的独立相关因素。
Objectibve To explore the risk factors of death in elderly patients with maintenance hemodialysis (MHD), and to provide reference for improving the prognosis of dialysis patients and reducing mortality. Methods The related data of elderly MHD patients (aged ≥ 80 years) in multiple centers were collected and retrospectively analyzed, and they were divided into death group and control group. Univariate analysis and logistic regression model were used to analyze the risk factors of death. RESULTS: a total of 112 elderly patients with MHD were included, including 26 deaths (23.214%). The first cause of death was cardiovascular events in 9 cases (34.615%). The type of vascular access (χ2= 4.825, P=0.028), primary disease (F =24.243, P=0.004), white blood cell count (t =-4.869, P＜0.001), lymphocyte count (t=3.400, P＜0.001), eosinophil count (t =2.895, P=0.005), albumin (t=3.089, P=00.003), prealbumin (t=3.247, P=0.002), total cholesterol (t = 2.037, P=0.044), cholinesterase (t=2.595, P=0.011) was statistically different between the two groups. Multivariate logistic regression analysis showed that diabetic nephropathy(OR=67.196,95% CI:5.034～896.973, P=0.001), hypertensive nephropathy (OR=15.577, 95% CI:1.765～137.477, P=0.013), high-level white blood cell count (OR=1.661, 95% CI:1.117～2.469, P=0.012) were independent risk factors for death in elderly patients with MHD. The high level of lymphocytes in the normal range (＞3.556×1012/L)(OR=0.120, 95% CI: 0.014～0.986, P=0.049) was the protective factor of death in elderly patients with MHD. Conclusion In this study, the main cause of death in elderly patients with MHD is cardiovascular events. Diabetes nephropathy, hypertensive nephropathy, high level of white blood cell count and lymphocyte level are independent related factors of death in elderly MHD patients.
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