武汉市血液透析死亡患者流行病学分析  

Epidemiological analysis of the death of maintenance hemodialysis patients in Wuhan city

作　　者：闵永龙 费世枝[1,2] 何达 陈芳[1] 程力[1] 张燕敏[1,2] 熊飞[1,2] MIN Yonglong;FEI Shi-zhi;HE Da;CHEN Fang;CHENG Li;ZHANG Yan-min;XIONG Fei(Department of Nephrology,The First Wuhan Hospital,Wuhan 430022,China;Wuhan Hemodialysis Quality Control Center,Wuhan 430022,China)

机构地区：[1]武汉市第一医院肾病内科,武汉430022 [2]武汉市血液透析质量控制中心,武汉430022

出　　处：《中国血液净化》2020年第8期562-565,共4页Chinese Journal of Blood Purification

基　　金：武汉市医学科研项目(WG18C01)。

摘　　要：目的回顾性分析2015~2018年武汉市维持性血液透析(maintenance hemodialysis,MHD)患者流行病学情况,为提高血液透析质量提供数据支持。方法以武汉市血液透析质量控制中心2015~2018年登记的患者为研究对象,分析死亡患者的流行病学情况。结果①MHD患者年度死亡率呈下降趋势(χ^2=22.668,P<0.001),死亡患者的透析龄呈延长趋势(χ^2=18.950,P<0.001);②透析1年内死亡患者比例呈降低趋势(χ^2=20.069,P<0.001)。③死亡患者原发病以糖尿病占比最高(26.4%),其次为高血压(25.1%)、原发性肾小球肾炎(22.1%);④死亡原因依次为心血管事件(25.3%)、脑血管事件(15.8%)、感染(5.9%)、消化道出血(3.6%)。⑤中年组(45~59岁)动静脉内瘘组(arteriovenous fistula,AVF)占比偏高,老年组(≥75岁)AVF占比最低(χ^2=45.927,P<0.001)。⑥通路为AVF的患者中位生存时间40(65,20)月,明显长于非AVF19(38,9)月,且2组患者生存曲线存在明显差异(χ^2=104.818,P<0.001)。结论武汉市MHD患者年度死亡率呈下降趋势,死亡患者透析龄呈延长趋势,原发病以糖尿病为主,死亡原因以心血管事件为首,通路为AVF的患者生存时间相对更长。Objective To retrospectively analyze the epidemiology of maintenance hemodialysis(MHD)in Wuhan in the period from 2015 to 2018 in order to provide the supporting data for the improvement of quality control of hemodialysis.Methods Information of the MHD patients registered in the Quality Control System of Dialysis in Wuhan from 2015 to 2018 was retrospectively studied.Age,sex,dialysis age,primary disease,vascular access pathway and cause of death of the patients were analyzed.Results①The decrease tendency of annual mortality was present in the MHD patients(χ^2=22.668,P<0.001),and their dialysis age became longer(χ^2=18.950,P<0.001).②Proportion of the MHD patients died in the first dialysis year became less(χ^2=20.069,P<0.001).③Diabetes accounted for the highest proportion of primary diseases in death cases(26.4%),followed by hypertension(25.1%)and primary glomerulonephritis(22.1%).④The cause of death was cardiovascular events(25.3%),cerebrovascular events(15.8%),infection(5.9%)and gastrointestinal bleeding(3.6%).⑤The proportion ofAVF in the middlEaged group(45~59 years old)was significantly higher than that in other age groups,and the proportion ofAVF in the elderly group was the lowest(χ^2=45.927,P<0.001).⑥The median survival time ofAVF patients was 40(65,20)months,significantly longer than that of 19(38,9)months in non-AVF patients(χ^2=104.818,P<0.001).Conclusion The annual mortality rate of MHD patients inWuhan city was decreasing.In the death MHD patients,dialysis age became longer,the most important primary disease was diabetes,the most important cause of death was cardiovascular events,and the survival time was relatively longer inMHDpatients withAVF.

关 键 词：维持性血液透析 死亡率 流行病学 

分 类 号：R19[医药卫生—卫生事业管理]