血液透析患者死亡原因分析  

Analysis of the death causes in patients treated with hemodialysis

作　　者：吕文律[1] 滕杰[1] 钟一红[1] 邹建洲[1] 王一梅[1] 汤颖[1] 龚邵敏[1] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾病科,上海200032

出　　处：《肾脏病与透析肾移植杂志》2011年第3期227-234,共8页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：上海市科委重大课题(08DZ1900602);教育部国家重点学科211三期重大项目(211XK20)

摘　　要：目的:分析血液透析(hemodialysis,HD)患者的死亡原因,探讨影响生存的相关危险因素,为提高HD患者生存率提供依据。方法:分析1998-01-01～2008-12-31HD死亡患者的临床资料,分析其死亡原因。结果:同期HD患者共811例,死亡237例,死亡患者透始中位年龄岁67(19～87岁),男性占60.8%,中位生存时间9.6月(0.1～96.6月)。主要死因为心血管疾病(20.3%)、脑血管疾病(16.5%)、感染(24.9%)[与非心脑血管疾病死因患者相比,死于心脑血管疾病的HD患者女性比例(43.7%vs36.7%,P<0.05)、糖尿病肾病的比例(25.0%vs11.1%,P<0.05)、HD前有左室肥厚史的比例(9.6%vs4.7%,P<0.05)、充血性心衰病史的比例(23.3%vs13.4%,P<0.05)较高,体质量指数(BMI)(21.1kg/m2vs23.6kg/m2,P<0.05)、eGFR(7.6ml/min·1.72m2vs10.0ml/min·1.72m2,P<0.05)较低]。Logistic回归分析提示BMI较低、透析前有充血性心衰史和左室肥厚史是HD患者死于心血管疾病的危险因素。与非感染死因患者相比,死于感染的HD患者透始年龄较大(66岁vs62岁,P<0.05)、透析前血白蛋白较低(30.2g/Lvs33.1g/L,P<0.05)。Logistic回归分析提示透始年龄大、透析前低白蛋白是HD患者死于感染的危险因素。33.3%患者于HD开始3月内死亡,其主要死亡原因为感染(38.0%)、心血管疾病(22.8%)、脑血管疾病(11.4%)。HD开始3月内死亡患者的慢性肾小球肾炎比例(20.6%vs36.2%,P<0.05)、透析前血钙(1.91mmol/Lvs2.18mmol/L,P<0.05)、血白蛋白(29.2g/Lvs34.7g/L,P<0.05)、CO2-CP(18.52mmol/Lvs22.15mmol/L,P<0.05)、eGFR(7.55ml/min·1.72m2vs10.29ml/min·1.72m2,P<0.05)均显著较低,HD前有充血性心力衰竭病史的比例(19.4%vs16.3%,P<0.05)、Charlson并发症指数(CCI)=5～10的比例(25.4%vs13.5%,P<0.05)显著较高。Logistic回归分析提示透析前低白蛋白血症、eGFR较低、充血性心力衰竭史、CCI≥5是HD3个月内死亡的危险因素。结论:HD患者主要死亡原因为心、脑血管疾病和感染。在HD开始3月内死亡风险较高,尤�Objective： To analyze the death causes in patients with hemodialysis, explore the risk factors affecting survival and provide some way to improve the survival of hemodialysis patients. Methodology ： The causes of death in patients with hemodialysis were retrospectively analyzed during the periods Jan. 1998 to Dec. 2008. Results：Two hundred and thirty seven cases in total eighty hundred eleven hemodialysis patients were died in the study period. Their average age at the beginning of hemodialysis was 63 （ 19 - 87） years old and men accounted for 60.8%. The median survival time was 9.6 （0. 1 - 96.6） months. The main causes of death in our patients were cardiovascular disease （20.3%） , infection （24.9%） and cerebrovascular disease （ 16.5% ）. [ The proportion of females （43.7% vs 36.7% , P 〈 0.05） and diabetic nephropathy as the underlying disease （25.0% vs 11. 1% , P 〈 0.05 ） was significantly higher and more patients had the history of left ventrieular hypertrophy （ 9.6% vs 4.7% , P 〈 0.05 ） and congestive heart failure （23.3% vs 13.4% , P 〈 0.05 ） before hemodialysis in patients died due to cardiovascular and cerebrovaseular diseases whose BMI （21. 1 vs 23.6 kg/m2 , P 〈 0.05 ） and eGFR （7.6 vs 10.0 ml/min 1.72m2, P 〈 0.05 ） before hemodialysis were lower. Logistic： regression analysis revealed that lower BMI, the history of left ventrieular hypertrophy and congestive heart failure before hemodialysis were the risk factors of dying due to cardiovascular and eerebrovaseular diseases. The patients died from infection were older （ 66 vs 62 years old, P 〈0.05 ） and their blood albumin before hemodialysis was lower （ 30.2 vs 33. 1 g/L, P 〈 0.05 ）. Logistic regression analysis showed that older patients, lower blood albumin before hemodialysis were the risk factors of dying from infection. 33.3 percent of the all deaths died within 3 months of hemodialysis. The main causes of death were infection （ 38.0% ） , cardiovascular diseas e（ 22.8% �

关 键 词：血液透析 死亡 心血管并发症 感染 早期生存率 

分 类 号：R459.5[医药卫生—治疗学]