单中心老年腹膜透析患者死亡原因及危险因素分析  

The causes of death and the risk factors of prognosis in elderly patients with peritoneal dialysis

作　　者：应俊[1] 李霜青[1] 刘艳 张晓辉 范秋萍 黄坚[1] YING Jun;LI Shuangqing;LIU Yan;ZHANG Xiaohui;FAN Qiuping;HUANG Jian(Department of Nephrology,Jinhua Municipal Central Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院肾内科,321000 [2]浙江大学医学院附属第一医院肾脏病中心

出　　处：《浙江医学》2021年第9期976-978,981,共4页Zhejiang Medical Journal

基　　金：金华市科学技术研究计划公益类项目(2017-4-027)。

摘　　要：目的分析老年腹膜透析患者的死亡原因及影响预后的危险因素。方法选取2010年1月1日至2015年8月30日在金华市中心医院开始行腹膜透析治疗老年患者134例。随访至2018年8月30日,其中死亡63例,存活71例。收集患者原发病情况、死亡原因;logistic回归分析患者死亡的独立危险因素;绘制ROC曲线分析各危险因素对判断患者死亡风险的灵敏度和特异度。结果老年腹膜透析患者最常见的原发病为慢性肾小球肾炎,主要死亡原因为心血管事件。logistic回归分析显示高龄(OR=0.921,95%CI:0.860~0.986)、低蛋白血症(OR=1.118,95%CI:1.039~1.204)、查尔森合并症指数评分(OR=0.429,95%CI:0.230~0.800)是影响老年腹膜透析患者死亡的独立危险因素(均P<0.05)。ROC曲线提示预测老年腹膜透析患者死亡风险的相关因素中年龄、查尔森合并症指数评分、血清白蛋白的最佳临界点分别为65.5岁、2.5分、36.25 g/L,灵敏度分别为0.762、0.492、0.598,特异度分别为0.549、0.761、0.683。结论心血管事件是老年腹膜透析患者的主要死亡原因。透析治疗开始前年龄>65.5岁、血清白蛋白水平<36.25 g/L、查尔森合并症指数评分>2.5分的老年腹膜透析患者需警惕发生不良预后。Objective To investigate the causes of death and the risk factors of prognosis in elderly patients with peritoneal dialysis. Methods Clinical data of 134 elderly patients with peritoneal dialysis in Jinhua Central Hospital from January 2010 to August 2015 were retrospectively analyze. Followed to August 30, 2018, among 134 patients 63 died and 71 survived. The risk factors for death of patients were analyzed with logistic regression, ROC curve was used to analyze the prognostic value of factors for the death. Results The most common primary disease was chronic glomerulonephritis and the most common cause of death was cardiovascular accident. Logistic regression analysis showed that age(OR=0.921, 95%CI:0.860~0.986), serum albumin(OR=1.118, 95%CI: 1.039~1.204) and Charlson’s comorbidity score(OR=0.429, 95%CI: 0.230~0.800) were the independent risk factors of death in elderly peritoneal dialysis patients(all P<0.05). ROC curve showed that the best cut-off values of age, Charlson’s comorbidity score and serum albumin for predicting adverse outcomes of patients were 65.5 years old, 2.5 points and 36.25 g/L with a sensitivities of 0.762, 0.492 and 0.598, and a specificity of 0.549, 0.761 and 0.683, respectively. Conclusion Cardiovascular events are the main cause of death in elderly peritoneal dialysis patients. Patients with age>65.5 years, Charlson’s comorbidity score >2.5, and serum albumin <36.25 g/L may have high risk for adverse prognosis.

关 键 词：老年患者 腹膜透析 死亡原因 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]