ANCA相关性小血管炎维持性透析患者的预后及危险因素研究

发布时间：2018-03-21 21:52

  本文选题：血液透析　切入点：腹膜透析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的研究抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibody,ANCA)相关性小血管炎(ANCA associated vasculitis,AAV)维持性透析患者的预后情况以及危险因素分析,为判断病情、选择治疗提供依据。方法回顾性分析2008年6月-2016年6月在浙江大学医学院附属第一医院肾脏病中心治疗并随访的AAV维持性透析患者资料,按ANCA类型分组比较器官受累情况、按透析方式分组比较感染情况、统计死亡原因、应用Kaplan-Meier法及Cox回归模型分析患者生存情况。结果入选123例AAV维持性透析患者,平均透析时间为1005±738天,其中腹膜透析(PD)35例(28.5%),血液透析(HD)88例(71.5%),中位随访34个月,患者死亡39例(31.7%)。AAV患者肺脏和肾脏受累多见,感染和心血管事件是主要死亡原因。按ANCA类型分组比较发现C-ANCA阳性组患者更易出现眼部损害。按透析方式分组比较发现HD组患者肺部感染发生率更高。单因素K-M法生存分析对比HD治疗组和PD治疗组,患者生存率差异无统计学意义。多因素COX回归模型分析显示年龄≥65岁、透析前患心血管疾病、透析前患间质性肺炎是影响AAV维持性透析患者生存的独立危险因素。结论AAV维持性透析患者应用HD治疗或者PD治疗,患者生存率差异无统计学意义。感染和心血管事件是AAV维持透析患者的主要死亡原因。年龄≥65岁、透析前心血管疾病史及透析前间质性肺炎史是影响AAV维持性透析患者生存的独立危险因素。
[Abstract]:Objective to study the prognosis and risk factors of maintenance dialysis patients with antineutrophil cytoplasmic antibody-Anca (ANCA associated vasculitis AAVA). Methods the data of AAV maintenance dialysis patients treated and followed up in the first affiliated Hospital of Zhejiang University Medical College from June 2008 to June 2016 were analyzed retrospectively. The organ involvement was compared according to ANCA type. Kaplan-Meier method and Cox regression model were used to analyze the survival of the patients. Results the average dialysis time was 1005 卤738 days in 123 patients with AAV maintenance dialysis. There were 35 cases of PDD with PDD and 71.5 cases with HD of hemodialysis. The median follow-up was 34 months, 39 cases died and 39 cases suffered from lung and kidney involvement. Infection and cardiovascular events were the main causes of death. Compared with ANCA group, C-ANCA positive group was more prone to ocular damage, and HD group had higher incidence of pulmonary infection according to dialysis method. Methods Survival analysis was used to compare HD group with PD group. There was no significant difference in the survival rate of the patients. Multivariate COX regression analysis showed that the age 鈮，

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