单中心维持性血液透析与腹膜透析患者生存率比较及影响因素  

Comparison of survival rate and analysis the influencing factors between maintenance hemodialysis and peritoneal dialysis in single-center

作　　者：张蓬杰[1] 荀利如[1] 丁通[1] 鲍楠[1] 段斌[1] ZHANG Pengjie;XUN Liru;DING Tong;BAO Nan;DUAN Bin(The Center of Kidney Diseases and Hemodialysis,Shanxi Provincial People’s Hospital,Xi′an 710068,China)

机构地区：[1]陕西省人民医院肾病血透中心,陕西西安710068

出　　处：《西部医学》2024年第2期248-252,共5页Medical Journal of West China

基　　金：陕西省社会发展科技攻关项目(2016SF-013)。

摘　　要：目的 探讨终末期肾脏病(ESRD)患者血液透析(HD)或腹膜透析(PD)治疗的生存差异及影响因素。方法 纳入2016年3月1日—2022年3月1日在我院行HD或PD治疗并长期随访的ESRD患者156例,其中HD 87例(HD组),PD 69例(PD组)。记录患者性别、年龄、体重、血压、尿量、原发病、血红蛋白、白蛋白、N端脑钠肽前体(NT-proBNP)、甲状旁腺激素(PTH)、残余肾功能、血肌酐、血尿素氮,观察终点事件为全因死亡。生存分析采用Kaplan-Meier分析,生存率比较采用log-rank检验。各因素对生存的影响采用多因素Cox回归风险分析。结果 两组患者性别、年龄、体重、尿量、原发病、血压、血红蛋白、白蛋白、NT-proBNP、PTH、残余肾功能、血肌酐、血尿素氮比较差异均无统计学意义(P>0.05)。HD组和PD组中位生存时间分别为36.0月、42.0月;HD组和PD组1、2、3、4、5年生存率分别为87.3%、80.5%、54%、39.1%、34.5%和86.9%、69.6%、55.1%、29%、24.6%。Log-rank检验显示两组患者生存率比较差异无统计学意义(χ^(2)=0.049,P=0.826)。多因素COX回归分析提示年龄、体重、高血压、NT-proBNP及PTH是终末期肾病患者生存率的影响因素(P=0.010、0.004、0.012、0.003、0.006)。年龄、体重、高血压及血红蛋白是HD组患者生存率的影响因素(P=0.002、0.027、0.023、0.011)。年龄、体重、尿量、血红蛋白及PTH是PD组患者生存率的影响因素(P=0.005、0.067、0.009、0.046、0.018)。结论 终末期肾病患者HD和PD治疗5年生存率比较无明显差异,年龄、体重、高血压、NT-proBNP及PTH是维持性透析患者生存率主要影响因素;HD患者年龄、体重、高血压及血红蛋白含量是生存率主要影响因素;而PD患者年龄、体重、尿量、血红蛋白含量及PTH是生存率主要影响因素。Objective To investigate the survival differences and influencing factors of patients with end-stage renal disease treated with hemodialysis(HD)or peritoneal dialysis(PD).Methods Patients with end stage renal disease(ESRD)who started HD or PD treatment at our nephrology hemodialysis center from March 1,2016 to March 1,2022 and were followed up in our department for a long period of time were selected.These patients were divided into HD group and PD group.The patient′s gender,age,weight,hypertension,urine volume,primary disease,hemoglobin,albumin,N-terminal pro brain natriuretic peptide(NT-proBNP),parathyroid hormone(PTH),residual renal function,blood creatinine,blood urea nitrogen were recorded.The end point of observation was all-cause death.Kaplan-meter analysis was used for survival analysis,and log-rank test was used for survival comparison.The influence of various factors on survival was analyzed by multivariate Cox-regression risk model.Spss22.0 was applied for statistical analysis.Results A total of 156 patients were eligible for enrollment,including 87 in HD group and 69 in PD group.There was no significant difference between the two groups in baseline data(p>0.05).The median survival time of HD group was 36.0 months,and the 1-year,2-year,3-year,4-year and 5-year survival rates were 87.3%,80.5%,54%,39.1%and 34.5%respectively.But the PD group was 42.0 months,and 86.9%,69.6%,55.1%,29%and 24.6%respectively.log-rank test showed that there was no significant difference in the survival rate between the two groups(χ^(2)=0.049,p=0.826).Multivariate Cox regression analysis of the basic data of the two groups showed that age,weight,hypertension,NT-proBNP and PTH were the influencing factors of the survival rate(p=0.010、0.004、0.012、0.003、0.006).Age,weight,hypertension and hemoglobin content were the influencing factors of survival rate in HD group(p=0.002,0.027,0.023,0.011).age,weight,urine volume,hemoglobin content and PTH were the influencing factors of survival rate in PD group(p=0.005,0.067,0.009,0.04

关 键 词：终末期肾脏病 血液透析 腹膜透析 生存率 影响因素 

分 类 号：R692.5[医药卫生—泌尿科学]