城乡终末期肾病患者开始血液透析时的特征分析和比较  

Analysis and comparison of rural and urban patients with end stage renal disease before hemodialysis

作　　者：崔晓萌[1] 钟一红[1] 龚劭敏[1] 许嵘[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：《复旦学报（医学版）》2011年第6期508-512,共5页Fudan University Journal of Medical Sciences

基　　金：上海市重大课题(08DZ1900602);教育部国家"211工程"重点学科建设项目(三期)(211XK20)

摘　　要：目的探讨城乡终末期肾病(end stage renal disease,ESRD)患者开始血液透析时的流行病学特征差异,为研究防治策略提供依据。方法对2000年1月至2008年12月在复旦大学附属中山医院血液净化中心开始血液透析的ESRD患者流行病学资料进行横断面分析。结果共928例患者,其中城市患者占69.61%,农村患者30.39%,农村患者平均年龄显著低于城市患者[(44.48±16.41)岁vs.(56.71±16.13)岁,P=0.000],透析前病程显著短于城市患者(28.5个月vs.51.5个月,P=0.000)。ESRD病因中农村患者慢性肾小球肾炎所占比例显著多于城市患者(67.38%vs.48.76%,P=0.000),糖尿病肾病(8.51%vs.13.47%,P=0.032)和高血压肾病(7.09%vs.12.07%,P=0.023)显著少于城市患者。农村患者血液透析前估算肾小球滤过率(estimated glomerular filtration rate,eGFR)显著低于城市患者[(4.98±3.72)mL.min-1.1.73m-2 vs.(5.48±3.04)mL.min-1.1.73m-2,P=0.032),血压显著高于城市患者(154.73/89.55mm Hg vs.149.43/85.96mm Hg,P<0.05,1mm Hg=0.133kPa),血红蛋白显著低于城市患者[(69.92±24.91)g/L vs.(74.60±25.64)g/L,P=0.001]。结论终末期肾病患者进入透析前,农村患者较城市患者年轻、病程短,透析前肾功能更差,高血压和贫血等并发症控制较差;病因中慢性肾小球肾炎更多见,而高血压肾病及糖尿病肾病则相对比例较少。应加强农村肾病患者的早期防治,有效控制并发症,及时接受透析治疗。Objective To investigate the epidemiologic differences between rural and urban patients with end stage renal disease（ESRD） before hemodialysis,providing reference for researching strategies of prevention and treatment.Methods The epidemiologic characteristics of the end stage renal disease patients who started hemodialysis in Zhongshan Hospital Blood Purification of Fudan University from 2000 Jan to 2008 Dec were analyzed.Results There were 928 patients（urban,69.61% versus rural,30.39%）.Rural patients was significantly younger than urban ones[（44.48±16.41） y vs.（56.71±16.13） y,P=0.000].Median disease duration of rural patients was shorter than that or urban ones（28.5 vs.51.5 months,P=0.000）.The top three causes of ESRD,chronic glomerulonephritis was more in rural area than urban（67.38% vs.48.76%,P=0.000）,while diabetic nephropathy（8.51% vs 13.47%,P=0.032）,and hypertensive nephropathy（7.09% vs.12.07%,P=0.023） were less.Average eGFR of rural patients was significantly lower than that of urban ones[（4.98±3.72） mL·min-1·1.73 m-2 vs.（5.48±3.04） mL·min-1·1.73 m-2,P=0.032].Blood pressure of rural patients was higher（154.73/89.55 mm Hg vs.149.43/85.96 mm Hg,P0.05,1 mm Hg=0.133 kPa）,while their hemoglobin was lower[（69.92±24.91） g/L vs.（74.60±25.64） g/L,P=0.001].Conclusions When ESRD patients start hemodialysis,rural patients are younger than urban patients,and have shorter disease duration.But their renal function is worse,with anemia and other complications controlled more poorly.Chronic glomerulonephritis accounts for the majority of the causes of rural patients,while diabetic nephropathy and hypertensive nephropathy accounts for smaller portions.It is important to strengthen the prevention and treatment of renal disease of rural patients in their early stage,control complications effectively,and initiate dialysis timely.

关 键 词：终末期肾病 血液透析 农村患者 贫血 高血压 

分 类 号：R692[医药卫生—泌尿科学]