维持性血液透析病人尿毒症脑病发病危险因素分析  

Analysis of risk factors for the development of uremic encephalopathy in maintenance hemodialysis patients

作　　者：邬政付 李正胜 谢娟 张雄峰 王叶 黄海平 李颖 WU Zhengfu;LI Zhengsheng;XIE Juan;ZHANG Xiongfeng;WANG Ye;HUANG Haiping;LI Ying(Department of Nephrology,Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang,Guizhou 550001,China)

机构地区：[1]贵州中医药大学第二附属医院肾内科,贵州贵阳550001

出　　处：《安徽医药》2022年第12期2493-2496,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的分析维持性血液透析病人尿毒症脑病发病的危险因素。方法收集2013年1月至2021年9月贵州中医药大学第二附属医院血液净化中心维持性血液透析合并尿毒症脑病病人,作为脑病组(共44例);采用单纯随机抽样法选取每例脑病病人发病同时期该中心维持性血液透析的非脑病病人1例,作为对照组(共44例)。对比两组病人临床资料,包括性别、年龄、感染合并率、糖尿病合并率、每周透析10 h以上比率、血尿素氮、血肌酐、血清β2微球蛋白(β2-MG)、血清全段甲状旁腺激素(iPTH)、血红蛋白浓度(HGB)、血清白蛋白(ALB)、尿素清除指数(Kt/V)≥1.2比率等,以二元logistic回归分析确立尿毒症脑病的独立危险因素。结果两组性别、年龄、糖尿病合并率、血尿素氮、血肌酐、β2-MG、iPTH差异无统计学意义(P>0.05);脑病组病人感染合并率显著高于对照组[36例(81.81%)比6例(13.63%)(P<0.05)];脑病组病人每周透析10 h以上比率、HGB、ALB、Kt/V≥1.2比率均显著低于对照组[29例(65.9%)比39例(88.63%)、(102.57±18.43)g/L比(113.93±15.15)g/L、(37.60±4.67)g/L比(41.69±4.07)g/L、9例(20.45%)比36例(81.81%),(P<0.05)];二元logistic回归分析结果显示感染合并率[OR=11.96,95%CI:(3.13,45.74)]、Kt/V≥1.2比率[OR=0.23,95%CI:(0.06,0.89)]是维持性血液透析病人发生尿毒症脑病的独立危险因素(P<0.05)。结论合并感染、透析不充分(Kt/V<1.2)是维持性血液透析病人尿毒症脑病发病的独立危险因素。Objective To analyze the risk factors for the development of uremic encephalopathy in maintenance hemodialysis pa⁃tients.Method Patients with uremic encephalopathy combined with maintenance hemodialysis in the blood purification center of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine were enrolled from January 2013 to September 2021 into the encephalopathy group(44 cases in total).One nonuremic encephalopathy patient on maintenance hemodialysis in the center dur⁃ing the same period of the onset of each encephalopathy case was selected by a simple random sampling method as the control group(44 cases in total).The clinical data of patients in the two groups were compared,including sex,age,infection coinfection rate,diabetes coin⁃fection rate,rate of dialysis more than 10 hours/week,blood urea nitrogen(BUN),serum creatinine(Scr),serum β2-microglobulin(β2-MG),serum whole segment parathyroid hormone(iPTH),hemoglobin concentration(HGB),serum albumin(ALB),ratio of urea clearance index(Kt/V)≥1.2,etc.Binary logistic regression analysis was used to determine the independent risk factors for uremic encephalopathy.Results There was no significant difference in in gender,age,diabetes merger rate,BUN,Scr,β2-MG,and iPTH between the two groups(P>0.05);the rate of coinfection was significantly higher than that of in the control group[36 cases(81.81%)vs.6 cases(13.36%),P<0.05];the rate of dialysis more than 10 hours/week,HGB,ALB and the ratio of Kt/V≥1.2 in the encephalopathy group were significant⁃ly lower than those in the control group[29 cases(65.9%)vs.39 cases(88.63%),(102.57±18.43)g/L vs.(113.93±15.15)g/L,(37.60±4.67)g/L vs.(41.69±4.07)g/L,9 cases(20.45%)vs.36 cases(81.81%),P<0.05];Binary logistic regression analysis showed that the rate of coinfection[OR=11.96,95%CI:(3.13,45.74)]and ratio of Kt/V≥1.2[OR=0.23,95%CI:(0.06,0.89)]were independent risk factors for the development of uremic encephalopathy in maintenance hemodialysis patients(P<0.05).Conclusion Coinfectio

关 键 词：肾透析 维持性血液透析 尿毒症脑病 回顾性分析 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学] R747.9[医药卫生—外科学]