浙江省腹膜透析患者人口统计及预后因素分析

发布时间：2018-04-02 07:04

本文选题：腹膜透析　切入点：人口统计学　出处：《浙江大学》2016年博士论文

【摘要】：第一部分浙江省腹膜透析患者人口统计学分析目的浙江省透析质量控制中心(Zhejiang Dialysis Quality and Management Center, ZDQM)登记腹膜透析患者相关信息,包括患者基本信息、病情转归、实验室检查结果等。本研究对2008-2015年ZDQM登记的腹膜透析患者资料进行分析,探究浙江省腹膜透析人群现况。方法数据来源于ZDQM数据库,各项数据内容均通过各中心网络在线填报并收集汇总。时间以2015年12月31日为止,导出数据库内所有录入腹膜透析患者的基本信息,包括出生日期、性别、诊断、首次透析日期、转归情况及原因、转归日期等。对其发病率、点患病率、年龄及性别构成、原发病病因、死亡时间及原因等进行统计分析。结果2008-2015年浙江省共有9145例腹膜透析患者登记。点患病率从14.16/百万人口上升至106.52/百万人口；新增患者平均年龄从49.94岁(2009年)上升至54.10岁(2015年)；在透患者平均年龄从52.41岁上升至55.19岁,以45-65岁患者为主体人群,65岁以上人群从22.4%上升至27.3%；男性患者多于女性患者；在透患者的平均透析龄从1.63年上升至2.73年,透析龄大于4年的患者比例由6.1%增长至23.0%。原发病病因前三位依次是慢性肾小球肾炎(占全体已知病因61.5%),糖尿病肾病(占12.8%)和高血压肾病(占8.8%)。退出腹膜透析登记系统患者占35.48%,其中转血液透析8.9%,肾移植6.5%,死亡11.0%；死亡原因以心脑血管事件为主,占30.5%,其次为感染(占10.8%)及恶性肿瘤(占5.4%)。转肾移植患者人数逐年增加,从2008年23人增长至2014年的124人。结论2008-2015年浙江省腹膜透析患病率持续上升,患者平均年龄逐渐增长,老年患者比例逐年上升,透析龄逐年增加,原发病以慢性肾小球肾炎为主,心脑血管事件为腹膜透析患者的主要死因,转肾移植患者数量逐年增加。第二部分腹膜透析患者预后及相关因素分析目的腹膜透析患者死亡风险高于普通人群,对ZDQM数据库中腹膜透析患者的资料信息及实验室基线数据进行回顾性分析,探究浙江省腹膜透析患者生存率及技术生存率的相关影响因素。方法数据来源于ZDQM数据库,以2015年12月31日为止,选取首次透析时年龄大于等于18岁、透析时间大于90天、转归情况明确及实验室基线数据全面的腹膜透析患者,统计患者开始透析时的基本信息、诊断、实验室结果等,采用Kaplan-Meier曲线、Log-Rank检验、及单因素Cox生存分析进行单因素分析,筛选出有统计学意义的因素进行多因素Cox生存分析,探究腹膜透析患者生存率及技术生存率的独立影响因素。结果浙江省腹膜透析患者1年、3年及5年的累计患者生存率分别为96.0%,87.3%,80.3%；1年、3年及5年的累计技术生存率分别为96.5%,87.2%,73.3%；多因素生存分析提示肿瘤病史(校正HR4.875,95%CI 1.530-15.537, P=0.007),初始年龄≥65岁(校正HR 2.807,95%CI 1.823-4.322, P0.001), C反应蛋白≥4mg/L(校正HR 1.984,95%CI 1.280-3.076, P=0.002),血清白蛋白≥35g/L(校正HR0.454,95%CI0.271-0.763, P=0.003)是腹膜透析患者生存率的独立影响因素；腹膜透析导管相关并发症(校正HR 4.674,95%CI 1.708-12.789, P=0.003),血清铁蛋白350≥ng/ml(校正HR 1.673,95%CI 1.097-2.549, P=0.017),女性(校正HR 0.612,95%CI 0.402-0.931, P=0.022)是腹膜透析技术生存率的独立影响因素。结论肿瘤病史、高龄、高C反应蛋白为腹膜透析患者生存率独立危险因素,高血清白蛋白为保护因素；腹膜透析导管相关并发症、高血清铁蛋白为腹膜透析技术生存率的独立危险因素,女性为保护因素。
[Abstract]:The first part of the statistical analysis in patients with peritoneal dialysis population in Zhejiang province to Zhejiang province dialysis quality control center (Zhejiang Dialysis Quality and Management Center, ZDQM) related information registration in peritoneal dialysis patients, including basic information, patient outcomes, laboratory examination results. This study is registered for 2008-2015 years ZDQM in peritoneal dialysis patients were analyzed retrospectively, explore the status of peritoneal dialysis in Zhejiang province population. Methods the data from the ZDQM database, the data center network content through the online reporting and collection time. By December 31, 2015, all entries in peritoneal dialysis patients basic information derived from the database, including the date of birth, gender, diagnosis, prognosis and date of dialysis for the first time, reason, vesting date. The incidence, point prevalence, age and gender, the etiology of primary disease, death time and causes Statistical analysis was carried out. The result of 2008-2015 years of Zhejiang province has a total of 9145 cases of peritoneal dialysis patients. The registration point prevalence from 14.16/ million population increased to 106.52/ million; increase the average age of the patients at the age of 49.94 (2009) up to 54.10 years of age (2015); in hemodialysis patients with Ping Junnian age increased from 52.41 years old to 55.19 years old, to a 45-65 year old patient population as the main body, 65 people over the age increased from 22.4% to 27.3%; male patients than female patients; the average age of dialysis hemodialysis patients rose from 1.63 to 2.73 years, more than 4 years of dialysis age the proportion of patients increased from 6.1% to 23.0%. causes the first three followed by the primary disease of chronic glomerulonephritis (accounted for all the 61.5% known cause), diabetic nephropathy (12.8%) and hypertensive nephropathy (8.8%). Exit registration system of peritoneal dialysis patients accounted for 35.48%, of which around 8.9% hemodialysis, 6.5% kidney transplantation, 11% died; cause of death Cardiovascular and cerebrovascular events, accounting for 30.5%, followed by infection (10.8%) and malignant tumors (5.4%). The number of renal transplant patients increased year by year, from 124 in 2008 to 23 growth in 2014 to 2008-2015 years in Zhejiang province. Conclusion the prevalence rate of peritoneal dialysis patients continued to rise, the age of Ping Junnian gradually increased, the proportion of elderly patients rise, dialysis age increased year by year, with primary disease of chronic glomerulonephritis, cardiovascular and cerebrovascular events were the main causes of death in patients with peritoneal dialysis, to number of renal transplant patients increased year by year. In the second part, the prognosis of patients with peritoneal dialysis and related factors analysis of peritoneal dialysis patients' risk of death than the general population, the information and laboratory baseline data of patients with peritoneal dialysis in ZDQM database were analyzed retrospectively, to explore the influence factors related to peritoneal dialysis in Zhejiang province with survival rate and survival rate. The technology method of data From the ZDQM database, in December 31, 2015 for the first time, selection of dialysis age more than 18 years, dialysis time more than 90 days, the outcome of peritoneal dialysis patients clear and laboratory comprehensive baseline data, basic information, statistics at the beginning of dialysis patients diagnosis, laboratory results, using the Kaplan-Meier curve, Log-Rank test and single the survival analysis of Cox factors were analyzed by univariate analysis, significant factors were screened by Cox multivariate survival analysis, explore the independent factors affecting the survival of peritoneal dialysis patients and survival. Results of peritoneal dialysis in Zhejiang Province in 1 years, 3 years and 5 years of cumulative survival rate were 96%, 87.3%, 80.3%; 1 years, 3 years and 5 years of accumulated technology survival rates were 96.5%, 87.2%, 73.3%; multivariate survival analysis showed that the history of cancer (adjusted HR4.875,95%CI 1.530-15.537, P=0.007), the initial year Age greater than 65 years (adjusted HR 2.807,95%CI 1.823-4.322, P0.001), C reactive protein (adjusted HR = 4mg/L 1.984,95%CI 1.280-3.076, P=0.002), serum albumin was 35g/L (adjusted HR0.454,95%CI0.271-0.763, P=0.003) is the survival of peritoneal dialysis patients independent factors; peritoneal dialysis catheter related complications (HR 4.674,95%CI 1.708-12.789 P=0.003 correction, serum). Ferritin 350 = ng/ml (HR 1.673,95%CI 1.097-2.549 P=0.017 correction, (HR), female 0.612,95%CI 0.402-0.931 correction, P=0.022) were independent factors affecting the survival rate of peritoneal dialysis technology. Conclusion the old history of cancer, C, high C-reactive protein in peritoneal dialysis patients survival rate independent risk factors and protective factors for high serum albumin; peritoneal dialysis catheter related complications, high serum ferritin as independent risk factors of survival rate of peritoneal dialysis technology, women were protective factors.

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R692.5

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