维持性血液透析患者初始状况与全因死亡相关危险因素分析  

Analysis of related risk factors of initial condition and all-cause mortality in MHD patients

作　　者：陈汝满 白亚飞[1] 庄君鑫 安娜[1] 王春莉 徐明芝[1] 李洪[1] CHEN Ru-man;BAI Ya-fei;ZHUANG Jun-xin(Department of Blood Purification,Hainan General Hospital-Hainan Hospital Affiliated to Hainan Medical College,Haikou 571300,China;不详)

机构地区：[1]海南省人民医院(海南医学院附属海南医院)血液净化中心,海南海口571300

出　　处：《中国医学装备》2022年第3期120-124,共5页China Medical Equipment

基　　金：海南省社会发展科技项目(SF201807)“γ干扰素释放实验与结核菌素皮试对血液透析患者隐形结核诊断对照研究”。

摘　　要：目的:观察维持性血液透析(MHD)患者首次透析时的实验室指标、肺部CT及一般资料等初始状况,以及血液透析开始至终点事件发生(全因死亡)的相关影响因素。方法:收集在医院血液净化中心完成血液透析且透析时间>3个月的274例MHD患者病历资料,所有患者均获得完整随访结果,根据随访结果将其分为生存组(192例)和死亡组(82例),以全因死亡作为预后观察指标,分析MHD患者起始透析时初始状况对全因死亡的影响。采用Cox回归分析MHD患者全因死亡相关危险因素;采用Kaplan-Meier生存曲线分析MHD患者生存情况。结果:在274例MHD患者中全因死亡82例(占29.93%)。两组患者原发病类别、肺部CT中主动脉钙化和肺结核情况比较,差异有统计学意义(χ^(2)=10.839,χ^(2)=5.019,χ^(2)=5.719;P<0.05);两组患者年龄、白蛋白(ALB)水平比较,差异有统计学意义(t=18.852,t=2.251;P<0.05);两组患者血尿素氮(BUN)、血肌酐(Scr)及左心房收缩末期内径(LAD)差异有统计学意义(U=-2.125,U=-3.529,U=-2.108;P<0.05)。MHD患者高龄、糖尿病肾病、主动脉钙化、肺结核或疑似肺结核及ALB、BUN、Scr低表达和LAD升高均为全因死亡的危险因素(HR=1.498,HR=2.018,HR=1.732,HR=2.4,HR=0.877,HR=0.908,HR=0.995,HR=0.864;P<0.05);274例MHD患者1年、2年、3年及4年生存率分别为90.15%、78.83%、64.60%和49.27%。结论:高龄、糖尿病肾病、主动脉钙化、LAD升高、肺结核或疑似肺结核及ALB、BUN、Scr低表达等均为MHD患者全因死亡的影响因素,临床中应重视其指标监测,定期复查心脏彩超及肺部CT,有效降低患者病死风险。Objective:To observe the initial conditions of patients who underwent maintenance hemodialysis(MHD) included laboratory indexes,pulmonary computed tomography(CT) and general data,as well as the related influencing factors from the beginning of hemodialysis to the occurrence of outcome event(all-cause death).Methods:274 MHD patients who completed hemodialysis in the blood purification center of hospital and whose times of hemodialysis were more than 3 months were collected.The entire follow-up results of all patients were obtained.These patients were divided into survival group(192 cases) and death group(82 cases) according to follow-up results.And the all-cause mortality was used as observed indicator of prognosis to analyze the effect of initial condition on all-cause mortality when MHD patients began to undergo hemodialysis.Cox regression analysis was adopted to analyze the related risk factors of all-cause mortality of MHD patients,and Kaplan-Meier survival curve was adopted to analyze the survival situation of MHD patients.Results:In 274 MHD patients,82 cases died of all-cause mortality.The differences of the classification of protopathy,aortic calcification and pulmonary tuberculosis in pulmonary CT between two groups were significant(χ^(2)=10.839,χ^(2)=5.019,χ^(2)=5.719,P<0.05).The differences of age and albumin(ALB) between two groups were significant(t=18.852,t=2.251,P<0.05).There were significant differences in blood urea nitrogen(BUN),blood creatinine(Scr) and left atrial end systolic inner-diameter(LAD) between the two groups(U=-2.125,U=-3.529,U=-2.108,P<0.05).Advanced age,diabetic nephropathy,aortic calcification,pulmonary tuberculosis or suspected pulmonary tuberculosis,as well as low expressions of ALB,BUN and Scr,and elevated LAD may be risk factors for all-cause mortality in MHD patients(HR=1.498,HR=2.018,HR=1.732,HR=2.4,HR=0.877,HR=0.908,HR=0.995,HR=0.864,P<0.05).The survival rates of 1-year,2-year,3-year and 4-year of 274 MHD patients were 90.15%,78.83%,64.60% and 49.27%,respectively.Conclusi

关 键 词：维持性血液透析(MHD) 初始状况 全因死亡 肺结核 主动脉钙化 

分 类 号：R459.5[医药卫生—治疗学]