单中心维持性血液透析患者新型冠状病毒感染状况调查及预后影响因素分析  

Investigation of COVID-19 infection status and analysis of prognostic factors in a single-center maintenance hemodialysis cohort

作　　者：王彦江[1] 王海琳 袁珊 袁心柱 谢席胜[1] 冯胜刚[1] WANG Yan-jiang;WANG Hai-lin;YUAN Shan;YUAN Xin-zhu;XIE Xi-sheng;FENG Sheng-gang(Department of Nephrology,the Second Clinical Medical School of the North Sichuan Medical College(Nanchong Central Hospital),Nanchong 637001,Sichuan,China;不详)

机构地区：[1]川北医学院第二临床医学院(南充市中心医院)肾内科,四川南充637001 [2]潆溪街道社区卫生服务中心公共卫生科,四川南充637200 [3]西充县人民医院肾内科,四川南充637200

出　　处：《广东医学》2024年第2期241-247,共7页Guangdong Medical Journal

基　　金：南充市社科研究“十四五”规划2023年度项目(NC23B025)。

摘　　要：目的调查维持性血液透析(maintenance hemodialysis,MHD)患者新型冠状病毒感染的患病率,并分析影响预后的相关因素,为更好地管理MHD患者提供依据。方法整群抽取280例MHD患者作为调查对象,调查MHD合并新型冠状病毒感染的患病率。筛选出其中感染新型冠状病毒的患者,根据预后情况的不同,将MHD新型冠状病毒感染患者分为痊愈组和死亡组,调查相关因素。结果共筛查出MHD合并新型冠状病毒感染患者265例,患病率为94.64%。死亡患者15例,病死率为5.66%。无症状感染者为30例(11.32%)。与痊愈组(n=250)患者相比,死亡组(n=15)患者发生乏力、纳差、咳嗽、咽喉肿痛、呼吸困难的比例更高,差异有统计学意义(P<0.05);与死亡组患者相比,痊愈组患者发生肌肉酸痛的比例更高,差异有统计学意义(P<0.05);两组患者在发热、嗅觉失敏、味觉失敏、头昏头痛、腹泻等症状的百分率方面比较,差异无统计学意义(P>0.05)。两组患者在原发疾病中的慢性肾炎,高血压,多囊肾,新型冠状病毒疫苗接种1剂次、2剂次、3剂次,透析龄,血磷、甲状旁腺激素水平、透析间期体重增长率、血红蛋白、空腹血糖以及血压等指标比较,差异无统计学意义(P>0.05)。与痊愈组患者相比,死亡组患者在原发疾病中的糖尿病比例及感染新型冠状病毒后发生病毒性肺炎的比例更高,透析间期更加缺少运动,年龄更大,血钙水平更低,炎症指标(白细胞计数、C反应蛋白、降钙素原、白细胞介素-6(interleukin-6,IL-6))更高以及存在更多的单室尿素清除指数(single-poolKt/V,spKt/V)不达标,差异有统计学意义(P<0.05)。结论原发疾病中的糖尿病、感染新型冠状病毒后发生的病毒性肺炎、透析间期缺乏运动、高龄、低血钙、高水平炎症指标(白细胞计数、C反应蛋白、降钙素原、IL-6)以及spKt/V不达标是引起MHD新型冠状病毒感染患者死亡的主要影响因素�Objective To investigate the incidence of COVID-19 infection in maintenance hemodialysis(MHD)patients and analyze factors influencing prognosis,providing insights for improved management of MHD patients.Methods A total of 280 MHD patients were systematically sampled for the investigation of COVID-19 infection inci-dence.Those infected were categorized into recovery and death groups based on prognosis,with relevant factors investiga-ted.Results Among 265 MHD patients with COVID-19 infection(94.64%incidence),15 deaths occurred,yielding a mortality rate of 5.66%.Asymptomatic infections were observed in 30 patients(11.32%).The death group(n=15)exhibited higher proportions of fatigue,poor appetite,cough,sore throat,and difficulty breathing compared to the recovery group(n=250)(P<0.05).The recovery group showed a higher proportion of muscle soreness compared to the death group(P<0.05).No significant differences were noted in fever,anosmia,ageusia,dizziness,headache,and diarrhea percentages(P>0.05).Additionally,no marked distinctions were found in primary diseases,COVID-19 vaccination doses,dialysis vintage,blood phosphate,parathyroid hormone,interdialytic weight gain,hemoglobin,fasting blood glucose,and blood pressure between the groups(P>0.05).The death group,however,had higher proportions of diabetes,post-COVID-19 viral pneumonia,less exercise during dialysis intervals,older age,lower blood calcium,elevated inflammatory indicators(white blood cell count,C-reactive protein,parathyroid hormone,interleukin-6),and more instances of substandard single-pool urea clearance index(spKt/V)(P<0.05).Conclusion Major factors influencing death in MHD patients with COVID-19 infection include diabetes,post-COVID-19 viral pneumonia,lack of exercise during dialysis intervals,advanced age,low blood calcium,elevated inflammatory indicators,and substandard spKvV.Encouraging exercise during dialysis intervals and improving dialysis adequacy can enhance the prognosis of MHD patients with COVID-19 infection.

关 键 词：血液透析 新型冠状病毒感染 预后 影响因素 疫苗接种 透析间期运动 病毒性肺炎 

分 类 号：R183.3[医药卫生—流行病学] R459.5[医药卫生—公共卫生与预防医学]