上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

维持性血液透析患者6年死亡情况及危险因素分析

方燕，张伟明，严玉澄，朱铭力，陆任华，倪兆慧，钱家麒   

  1. 上海交通大学 医学院附属仁济医院肾脏科， 上海 200127
  • 出版日期:2016-03-28 发布日期:2017-06-02
  • 通讯作者: 张伟明, 电子信箱: weimingzh1965@163.com。
  • 作者简介:方燕（1979—）， 女， 主治医师， 硕士生; 电子信箱: fangyan_fyfy@126.com。
  • 基金资助:

    上海市重大科研项目（08DZ1900500）

Analysis of 6year morality and its risk factors in patients undergoing maintenance hemodialysis

FANG Yan, ZHANG Wei-ming, YAN Yu-cheng, ZHU Ming-li, LU Ren-hua, NI Zhao-hui, QIAN Jia-qi   

  1. Department of Nephrology， Renji Hospital， Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2016-03-28 Published:2017-06-02
  • Supported by:

    Major Scientific Research Projects in Shanghai， 08DZ1900500

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摘要：

目的 分析维持性血液透析（MHD）患者的死亡情况，为提高MHD患者的长期生存率提供依据。方法 收集2009年1月1日—2014年12月31日首次入院的MHD患者的临床资料，分析死亡原因及相关危险因素。结果 共纳入176例患者，首次透析年龄为（58.2±16.1）岁，平均随访时间为（37.6±22.0）月；死亡33例（18.8%），总体病死率为59.7/1 000病人年；主要死亡原因为心脑血管疾病，共15例（45.6%）。与存活组比较，死亡组患者的首次透析年龄较大（P=0.000）；吸烟和既往合并心血管事件者比例较高（P=0.045，P=0.002）；起始透析频率较高（P=0.004）；透析前血红蛋白浓度和血细胞比容较低（P=0.011，P=0.012），血清高敏C反应蛋白水平较高（P=0.036），内生肌酐清除率较低（P=0.049）。Cox回归分析结果提示首次透析年龄（HR=1.033，95%CI 1.007~1.061）和透析前血红蛋白浓度（HR=0.980，95%CI 0.962~0.998）是MHD患者死亡的独立危险因素。结论 MHD患者的主要死亡原因为心脑血管疾病。首次透析年龄越大、透析前血红蛋白浓度越低，则患者的死亡风险越大。

关键词: 维持性血液透析, 死亡, 危险因素, 心脑血管疾病

Abstract:

Objective To analyze deaths of patients undergoing maintenance hemodialysis (MHD) and provide evidence for improving longtime survival in MHD patients. Methods Clinical data of MHD patients admitted in our hospital for the first time from January 1, 2009 to December 31, 2014 were collected and causes of death and related risk factors were analyzed. Results One hundred and seveny-six patients were enrolled. The mean age of starting hemodialysis was 58.2±16.1 years old and the mean duration of follow-up was 37.6±22.0 months. There were 33 patients (18.8%) died and the total mortality was 59.7/1 000 patients/year. The main course of death was cardiovascular and cerebrovascular diseases, which resulted in 15 deaths (45.6%). Compared with the survival group, patients in the death group had an older mean age of starting hemodialysis (P=0.000), higher proportion of patients who smoked and had a history of cardiovascular events (P=0.045, P=0.002), higher starting hemodialysis frequency (P=0.004), lower hemoglobin level and haematocrit before hemodialysis (P=0.011，P=0.012), higher level of serum high sensitivity C reactive protein (P=0.036), and lower creatinine clearance rate (P=0.049). Cox regression analysis showed that the age of starting hemodialysis (HR 1.033, 95%CI 1.007-1.061) and hemoglobin level before hemodialysis (HR 0.980, 95%CI 0.962-0.998) were independent risk factors of death in MHD patients. Conclusion The main cause of death in MHD patients are cardiovascular and cerebrovascular diseases. Older age of starting hemodialysis and lower hemoglobin level before hemodialysis cause higher death risk in MHD patients.

Key words: maintenance hemodialysis, death, risk factor, cardiovascular and cerebrovascular disease