老年终末期肾病患者血液透析和腹膜透析的生存率影响素分析  

Analysis of influencing factors on survival rate of hemodialysis and peritoneal dialysis in elderly patients with end-stage renal disease

作　　者：张席军[1] 李红莉[1] 陈延平[2] 赵筱娟 ZHANG Xijun;LI Hongli;CHENG Yanping;ZHAO Xiaojuan(Department of Oncology,Yan′an People′s Hospital,Yan′an Shanxi 716000,China;Department of Internal Medicine,the Affiliated Hospital of Yan′an University,Yan′an Shanxi 716000,China)

机构地区：[1]陕西省延安市人民医院肾内科,陕西延安716000 [2]延安市延安大学附属医院内科,陕西延安716000

出　　处：《新疆医科大学学报》2021年第1期76-79,共4页Journal of Xinjiang Medical University

基　　金：陕西省延安市社会发展科技攻关项目(2016sf-120)。

摘　　要：目的探讨影响老年终末期肾病患者两种血液净化方式治疗后生存率的相关因素。方法收集延安市人民医院于2015年1月—2018年12月收治的100例老年终末期肾病患者的临床资料,患者均采取3个月以上的持续透析治疗。根据患者透析方式的不同,分为甲组(血液透析)52例和乙组(腹膜透析)48例。记录两组患者临床转归情况,并分析患者死亡原因,采用Cox多因素回归分析影响老年透析患者生存率的相关因素。结果甲组2例转换成腹膜透析,4例失访,5例需要肾移植,41例死亡;乙组5例转换成血液透析,2例失访,4例需肾移植,37例死亡。两组临床转归情况、死亡原因及生存率比较,差异无统计学意义(P均>0.05);高龄、透析开始时Charlson并发症指数(CCI)不低于5、原发病为糖尿病肾病均是影响老年血液透析患者生存率的独立影响因素(P均<0.05)。高龄、血浆白蛋白<35 g/L、前白蛋白>30 g/L均是影响老年腹膜透析患者生存率的独立影响因素(P均<0.05)。结论老年终末期肾病患者两种血液净化方式生存预后及生存率的影响因素均不相同,临床应根据老年患者具体情况,采取不同的透析方法。Objective To analyze and explore the relevant factors affecting the survival rate of the elderly patients with end-stage renal disease after treatment with two blood purification methods.Methods The clinical data of 100 elderly patients with end-stage renal disease admitted to Yan'an People's Hospital from January 2015 to December 2018 were collected.The patients were treated with continuous dialysis for more than 3 months.According to the different dialysis methods of patients,they were divided into 52 cases in group A(hemodialysis)and 48 cases in group B(peritone⁃al dialysis).The clinical outcomes of the two groups of patients were recorded,and the causes of death of the patients were analyzed.Cox multivariate regression analysis was used to analyze the relevant factors affecting the survival rate of elderly dialysis patients.Results Two cases in the group A were converted to peritoneal dialysis,4 cases were lost to follow-up,5 cases required kidney transplantation,and 41 cases died;5 cases in the group B converted to hemodialysis,2 cases were lost to follow-up,4 cases required kidney transplantation,and 37 cases died.There was no significant difference in clinical outcome,cause of death and survival rate between the two groups(all P>0.05).Old age,CCI not less than 5 at the beginning of dialysis,and diabetic nephropathy as the primary disease are independent factors affecting the survival of the elderly hemodialysis patients(all P<0.05).Old age,plasma albumin<35 g/L,prealbumin>30 g/L are all independent factors affecting the survival rate of the elderly peritoneal dialysis patients(all P<0.05).Conclusion The factors affecting the survival prognosis and survival rate of the two blood purification methods in the el⁃derly patients with end-stage renal disease are not the same.Clinically,different dialysis methods should be adopted according to the specific conditions of elderly patients.

关 键 词：老年 终末期肾病 血液透析 腹膜透析 生存率 影响因素 

分 类 号：R692.5[医药卫生—泌尿科学]