多状态Markov模型在慢性肾脏病分级预后研究中的应用  

Application of Markov model in studying graded prognosis of chronic kidney disease

作　　者：刘迅[1,2] 凌莉[3] 王成[1] 陈珠江[1] 石成钢[1] 唐骅[1] 娄探奇[1] 

机构地区：[1]中山大学附属第三医院肾内科,广州510630 [2]华南理工大学生物工程学院,广州510640 [3]中山大学医学统计与流行病学系,广州510080

出　　处：《第二军医大学学报》2009年第7期804-807,共4页Academic Journal of Second Military Medical University

摘　　要：目的:探讨慢性肾脏病(CKD)患者的CKD各期进展情况,构建初步的分级预后多状态Markov模型。方法:对272例CKD随访病例进行回顾性研究,建立包含CKD1期、CKD2期、CKD3期、CKD4期、CKD5期、死亡/终末期肾病期6个状态的Markov模型,探讨患者的分级预后。结果:平均观察年限2.0年。CKD1-2期转移的概率为9.2%/年,CKD2-3期转移的概率为10.9%/年,CKD3-4期转移的概率为13.2%/年,CKD4-5期转移的概率为16.1%/年,CKD5期-死亡/终末期肾病转移的概率为47.1%/年。以多状态Markov模型预期本队列今后50年处于CKD1期的平均时间为11.1年,处于CKD2期的平均时间为7.8年,处于CKD3期的平均时间为5.4年,处于CKD4期的平均时间为2.5年,处于CKD5期的平均时间为1.0年,预期平均寿命或肾存活期为27.8年。结论:应根据CKD不同分期的预后及其影响因素评估患者病情和指导临床治疗。Objective： To evaluate the progression of chronic kidney disease （CKD） in CKD patients and to establish a Markov model for graded prognosis of CKD. Methods： A total of 272 CKD patients were retrospectively investigated. A Markov model consisting of six states （CKD1 stage,CKD2 stage,CKD3 stage,CKD4 stage,CKD5 stage as well as death/end-stage renal disease [ESRD] stage） was established. Results： The mean follow-up period was 2.0 years. Transition rates from CKD1 stage to CKD2 stage,from CKD2 stage to CKD3 stage, from CKD3 stage to CKD4 stage, from CKD4 stage to CKD5 stage and from CKD5 stage to death/ESRD stage were 9.2 %/year, 10.9 % / year, 13.2 % /year, 16.1 %/year, and 47.1 %/year, respectively. The Markov model estimated that the mean duration of CKD1 stage, CKD2 stage, CKD3 stage, CKD4 stage, CKD5 stage and death/ ESRD stage in our cohort were 11. 1 years,7.8 years,5.4 years,2.5 years and 1.0 years,respectively. The mean renal survival time or dialysis free period was 27.8 years. Conclusion： Evaluation of severity and the treatment of CKD patients should be done aecording to the prognoses of CKD patients at different stages.

关 键 词：多状态MARKOV模型 慢性肾脏病 预后 

分 类 号：R181.2[医药卫生—流行病学] R692[医药卫生—公共卫生与预防医学]