维持性血液透析患者的临床及预后分析  

Clinical and prognosis analysis of maintenance hemodialysis patients

作　　者：布合力其·麦麦提[1] 莫颖[1] 张蕾[1] 冯琦[1] 徐超 Maimaiti Buheliqi;Ying Mo;Lei Zhang;Qi Feng;Chao Xu(Department of Nephrology,The Fifth Affiliated Hospital of Xinjiang Medicial University,Urumqi,XinJiang 830011,China)

机构地区：[1]新疆医科大学第五附属医院肾病科,新疆乌鲁木齐830011

出　　处：《中国现代医学杂志》2022年第7期77-83,共7页China Journal of Modern Medicine

摘　　要：目的回顾性分析单中心维持性血液透析患者的临床资料及预后。方法收集2013年1月—2018年10月新疆医科大学第五附属医院血液净化中心透析龄≥3个月的维持性血液透析患者的病历资料,包括性别、年龄、透析龄、原发病、透析血管通路、血压、血生化指标、单室尿素清除指数(spKt/V)、药物使用情况等,对维持性血液透析患者的预后、生存率及相关因素进行分析。各种相关数据的采集通过全国血液净化病例登记系统完成。结果共收集209例维持性血液透析患者,男性124例,女性85例,平均年龄(61.81±13.33)岁,中位透析龄40.50(27.50,62.00)个月。原发病:糖尿病肾病82例(39.23%),慢性肾小球肾炎63例(30.14%),高血压肾病22例(10.53%),多囊肾病10例(4.78%),梗阻性肾病8例(3.83%),狼疮肾炎8例(3.83%),急性肾损伤5例(2.39%),原因不详11例(5.27%)。动静脉内瘘150例(71.77%)、长期中心静脉导管56例(26.79%)、移植物动静脉内瘘2例(0.96%),临时导管1例(0.48%)。透析前平均收缩压为(148.17±19.84)mmHg。患者的平均血红蛋白水平为(100.13±21.01)g/L,铁蛋白水平为216.40(96.40,457.30)ng/mL,转铁蛋白饱和度为27.68(19.40,41.46)%,血钙水平为2.19(2.04,2.32)mmol/L,血磷水平为(1.62±0.56)mmol/L,iPTH水平为198.95(113.31,419.05)ng/L,平均血清白蛋白水平为(34.67±5.47)g/L。研究期间死亡70例(33.49%),心脑血管事件是患者死亡的主要原因,心血管疾病死亡41例,死亡原因第2位是感染。患者1年、3年、5年生存率分别为99.5%、83.5%、60.2%。COX回归分析结果显示,使用长期中心静脉导管[OR^(^)=2.314(95%CI:1.269,3.590)]、spKt/V≥1.2[OR^(^)=0.482(95%CI:0.204,0.820)]、使用磷结合剂[OR^(^)=0.405(95%CI:0.227,0.720)]是患者全因死亡的独立危险因素(P<0.05);年龄>60岁[OR^(^)=2.824(95%CI:1.313,6.072)]、使用长期中心静脉导管[OR^(^)=2.120(95%CI:1.043,4.306)]、透析前收缩压>145 mmHg[OR^(^)=3.547(95%CI:1.626,3.399)]、spKt/Objective To analyze the clinical date and prognosis of MHD patients in our hemodialysis center.Methods We retrospectively reviewed the clinical records of MHD patients treated for more than 3 months in the blood purification center,the fifth affiliated Hospital of Xinjiang Medicial University,during January 2013 to October 2018.Gender,age,dialysis vintage,primary renal disease,vascular access type,blood pressure,blood biochemical index,spKt/V,cause of death,survival rate,and risk factors were analyzed.All related data were collected through the Chinese National Renal Data System.Results A total of 209 patients were recruited,124 were males and 85 were females.The average age was(61.81±13.33)years,and the median dialysis age was 40.50(27.50,62.00)months.The top 3 primary causes of ESRD were diabetic nephropathy(39.23%),glomerulonephritis(30.14%),and hypertensive nephrosclerosis(10.53%).Cuffed-tunneled catheters accounted for 26.79%,artificial blood vessels were used in 2 cases.The average level of hemoglobin(Hb)was(100.13±21.01)g/L,the rate of Hb compliance was 25.83%,according to the standard of Hb between 110 to 120 g/L.The rates achieved to the recommended levels of blood calcium,blood phosphorus and iPTH were 56.46%,52.15%and 43.10%respectively.The mean systolic blood pressure before dialysis was(148.17±19.84)mmHg.During the follow-up period,70 cases died(33.49%),of which 19.62%died of cardiovascular diseases,cardiovascular and cerebrovascular incidences were the leading causes of death,the second cause of death is infection.The survival rate of MHD patients was different:99.5%in one year,83.5%in three years,and 60.2%in five years.Cox regression analysis showed that the use of long-term central venous catheter[OR^(^)=2.314(95%CI:1.269,3.590)],spKt/V≥1.2[OR^(^)=0.482(95%CI:0.204,0.820)]and phosphorus binder[OR^(^)=0.405(95%CI:0.227,0.720)]were independent risk factors for allcause death(P<0.05).Age>60 years[OR^(^)=2.824(95%CI:1.313,6.072)],use of long-term central venous catheter[OR^(^)=2.120(95%CI:1.043,

关 键 词：终末期肾病 维持性血液透析 生存率 

分 类 号：R692.5[医药卫生—泌尿科学]