成人维持性血液透析患者早期病死率及相关风险分析  

Early mortality and risk analysis in adult patients with maintenance hemodialysis

作　　者：陈有维 盛凯翔[1] 姚曦 徐春萍[1] 瞿立辉[1] 郭琦[1] 陈江华[1] 张萍[1] Chen Youwei;Sheng Kaixiang;Yao Xi;Xu Chunping;Qu Lihui;Guo Qi;Chen Jianghua;Zhang Ping(Kidney Disease Center,the First Affiliated Hospital,Medical College of Zhejiang University,Hangzhou 310006,China;the Department of Nephrology,Second Affiliated Hospital of Jiaxing Medical College,Jiaxing,Zhejiang 314000,China)

机构地区：[1]浙江大学医学院附属第一医院腎脏病中心,杭州310003 [2]嘉兴医学院附属第二医院肾内科,浙江省嘉兴市314000

出　　处：《中华内科杂志》2021年第1期35-40,共6页Chinese Journal of Internal Medicine

基　　金：国家公益性行业科研专项(201502010)。

摘　　要：目的:通过分析成人维持性血液透析(MHD)患者早期(120 d内)病死率,探究影响透析早期死亡危险因素并建立风险预测模型,为提高MHD患者生存率提供研究依据。方法:选2008年1月1日—12月31日年浙江大学医学院附属第一医院肾脏病中心成人MHD患者4885例,分为预测模型组(3603例)和验证模型组(1282例)。对预测模型组采用多因素logistic回归分析120 d内死亡危险因素并建立预测模型,绘制受试者操作特征(ROC)曲线,评价模型预测能力。结果:4885例MHD患者120 d内累积病死率为20.97/100人年,365 d为12.25/100人年。预测模型组多因素logistic回归分析显示,首次透析年龄>60岁(OR=1.792)、非慢性肾小球肾炎(OR=2.214)、合并心脑血管疾病(OR=2.695)、血白蛋白<35 g/L(OR=1.358)、血小板计数<120×10^(9)/L(OR=2.194)、血肌酐<600μmol/L(OR=1.652)、尿素氮>30 mmol/L(OR=1.887)、血磷<1.13 mmol/L(OR=1.783)、脉压差>55 mmHg(1 mmHg=0.133 kPa)(OR=1.656)、低密度脂蛋白<1.5 mmol/L(OR=1.873)、血钙>2.5 mmol/L(OR=1.876)为MHD患者早期死亡的危险因素(P值均<0.05),据此建立风险预测模型。验证模型组ROC曲线下面积为0.810,敏感度为85.7%,特异度为62.5%。结论:成人MHD患者透析后120 d内病死率较高,根据危险因素建立的预测模型可有效预测透析早期死亡风险。Objective To retrospectively analyze the early mortality and related risk factors in adult patients with maintenance hemodialysis(MHD).Methods Adult MHD patients from 2008 to 2018 were enrolled and divided into training data group and validation data group.In training data group,multivariate logistic regression was used to analyze the risk factors of early death within 120 days after hemodialysis and establish a prediction model.The receiver operating characteristic(ROC)curve was applied to evaluate the prediction ability of the model.Results A total of 4885 patients were included.The cumulative mortality within 120 days was 20.97/100 person years,and that within 365 days was 12.25/100 person years.A total of 3603 patients in the training data group were analyzed.The following risk factors were correlated with early mortality(all P<0.05),including age at start of dialysis over 60 years old(OR=1.792),non-chronic glomerulonephritis(OR=2.214),cardio-cerebrovascular disease(OR=2.695),plasma albumin less than 35 g/L(OR=1.358),platelet count less than 120×10^(9)/L(OR=2.194),serum creatinine less than 600μmol/L(OR=1.652),blood urea nitrogen over 30 mmol/L(OR=1.887),blood phosphorus less than 1.13 mmol/L(OR=1.783),pulse pressure over 55 mmHg(1 mmHg=0.133 kPa)(OR=1.656),low density lipoprotein less than 1.5 mmol/L(OR=1.873),and blood calcium over 2.5 mmol/L(OR=1.876).Risk prediction model was established.The other 1282 cases in the validation data group were verified.The area under ROC curve was 0.810,with sensitivity 85.7%,and specificity 62.5%.Conclusion The mortality rate of adult MHD patients within 120 days after dialysis is high.The established prediction model can effectively predict the risk of early death.

关 键 词：透析 死亡 危险因素 LOGISTIC模型 

分 类 号：R692.5[医药卫生—泌尿科学]