以KDIGO的诊断标准评估住院老年CKD的临床研究

发布时间：2018-05-13 00:31

本文选题：老年 + 慢性肾脏病　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]1.分析老年慢性肾脏病(Chronic Kidney Disease,CKD)的临床特点,为老年CKD的诊断、治疗提供帮助。2.明确高危人群(老年住院患者)中CKD的病因,为临床提早发现老年CKD提供有力依据。3.通过分析老年CKD的临床特点及病因,指导老年CKD的早期防治,提高患者生活质量,延长患者的生存时间。[方法]回顾性分析昆明医科大学第一附属医院肾内科2016年1月1日至2016年12月31日收治的年龄≥65岁住院患者基本资料。排除条件如下:①年龄65岁;②病史小于3个月;③资料不全的患者。[结果]1.本次共计调查2198人,≥65岁310人,老年CKD286人,占92. 26%,老年非CKD24人,占7. 74%;男性192人,占61.94%,女性118人,占38. 06%,平均年龄为72. 49±5. 543岁;各年龄段中,分别为≤69岁115人,占37. 10%,70-75 岁 109 人,分别占 35.16%, 76-80 岁 58 人,占 18. 71%,≥81 岁 28 人,占9.03%;老年CKD各期中,G1、G2、G3a、G3b、G4、G5分别为135人、28人、21 人、49 人、44 人、9 人,分别占 47. 20%、9. 79%、7. 34%、17. 13%、15. 38%、3.15%。2.本次调查研究发现,老年CKD的病因中,高血压178人,占62. 24%、糖尿病36人,占12. 59%、慢性肾炎25人,占8. 74%、痛风22人,占7. 96%、慢性间质性肾炎8人,占2. 8%,结缔组织病4人,占1.40%、多囊肾3人,占1.05%、其他10人,占3. 50%。老年CKD的主要病因是高血压。3.本次调查研究发现,老年CKD各年龄段中主要病因是高血压,≤69岁、70-75 岁、76-80 岁、≥81 岁分别占 60. 95%、61.54%、61.54%、72.00%;老年CKD各期中主要病因是高血压,G1、G2、G3a、G3b、G4、G5分别占60. 74%、60. 71%、57.14%、65. 31%、65. 91%、66. 67%;透析患者 65 人,占 14. 68%,非透析患者 221人,占 77. 27%。4.经x2检验分析发现,老年CKD组与老年非CKD组中,年龄(x 2=2. 562,P=0.464)无统计学差异;性别(x2=11.849,P=0.001)、尿蛋白(x2=19.903,P0.001)、尿潜血(x2=6. 673,P=0. 010)有统计学差异。老年CKD男性(96.35%)高于女性(85. 59%) 。5.经t检验分析发现,老年CKD组与老年非CKD组总胆固醇(t=-1.457,P=0.146)、钙(t=0.244,P=0. 808)、白蛋白(t=0.275,P=). 783)无统计学差异;老年CKD组与老年非CKD组血红蛋白(t=-6.556, P0.001)、红细胞(t=-4.970, P0.001)、尿酸(t=3.323,P=0.001)、磷(t=3.805, P=0.001)有统计学差异,老年CKD组血红蛋白、红细胞低于老年非CKD组;老年CKD组尿酸、磷高于老年非CKD组。6.经秩和检验分析发现,老年CKD组与老年非CKD组甘油三酯无统计学差异(Z=1. 083, P=0.191);老年 CKD 组与老年非 CKD 组尿素(Z=2. 737, P0.001)、肌酐(Z=3.079, P0.001)、胱抑素-C (Z=3.064, P0.001)有统计学差异;老年CKD组尿素、肌酐、胱抑素-C高于老年非CKD组。7.经方差分析发现,老年CKD组各期的尿酸(F=1.709,P=0.133)、钙(F=1.684,P=0.138)、白蛋白(F=2.027, P=0.075)无统计学差异;老年 CKD组各期血红蛋白(F=42.715, P0.001)、红细胞(F=37.893,P0.001)、磷(F=31.121,P0. 001)有统计学差异;经两两比较分析发现,血红蛋白、红细胞从G1到G3b逐渐下降,磷从G1到G4逐渐升高。8.经秩和检验分析发现,老年CKD组各期甘油三酯(H=5.184,P=0.398)无统计学差异;老年CKD组各期尿素(H=187. 741,P0.001)、肌酐(H=248. 711,P0.001)、胱抑素C (H=200.387, P0.001)有统计学差异;经两两比较分析发现,尿素、肌酐、胱抑素-C从G1到G5逐渐升高。9.经统计分析发现,尿素(P=0.00,OR=1. 355, 95C. I.%=1.157-1.585)、肌酐(P=0.02, OR=1.011,95C. I.=%1.004-1.108)、尿酸(P=0.001,OR=1.007,95C. I. =%1.003-1. 011)、胱抑素-C(P0.001, OR=4. 765, 95C. I. %=2. 304-9.851)、磷(P=0.019, OR=4. 820, 95C. I. %=1. 289-18. 032)、红细胞(P=0.002, OR=0.463,95C. I. %=0. 285-0. 750)、血红蛋白(P=0. 001, OR=0. 972, 95C. I. %=0. 957-0. 988)、尿蛋白A3级(P=0.014, OR=3.404,95C.I.=1.282-9.037)、尿潜血(P=0.014,OR=3. 309, 95C.I. =1.276-8. 578)为老年CKD的敏感指标,有统计学差异。10.经统计分析发现,胱抑素-C(P=0.001、OR=3. 4、95%C.I.=1.687-6. 855)是发现老年CKD的早期敏感指标,有统计学差异(P=0.001)。11.当肌酐临界值为为123.80umol/L,其特异度0.917,敏感度0.738;当胱抑素-C的临界值为1.88 mg/L时,其特异度0.875,敏感度0.776,此时可能为诊断早期肾功能损害的最佳临界点。对肌酐和胱抑素-C判定结果做ROC曲线,肌酐曲线下面积为0.864,胱抑素-C曲线下面积为0.886,发现两者对老年CKD有高度诊断价值,且胱抑素-C较肌酐有更高的诊断价值。12.本研究发现,老年CKD死亡9人,占3. 15%,老年非CKD死亡0人;老年CKD死亡病因中,高血压5人,占55. 55%,糖尿病2人,占22. 22%,痛风1人,占11.11%,多囊肾1人,占11.11%;老年CKD死亡原因中,多器官功能衰竭6人,占66. 67%,浓毒血症2人,占22. 22%,肺部感染1人,占11.11%。[结论]1.高血压、糖尿病、慢性肾炎为老年CKD的常见病因,其次为糖尿病、慢性肾炎、痛风、慢性间质性肾炎、结缔组织病、多囊肾。2.经统计分析发现,尿素、肌酐、尿酸、胱抑素-C、磷、红细胞、血红蛋白、尿蛋白、尿潜血是老年CKD的敏感指标。3.对肌酐和胱抑素-C判定结果做ROC曲线,发现两者对老年CKD有高度诊断价值,且胱抑素-C优于肌酐。
[Abstract]:[Objective]1. to analyze the clinical characteristics of Chronic Kidney Disease (CKD) for elderly patients with chronic renal disease (CKD), for the diagnosis of CKD in the elderly and to provide help for.2. to clear the cause of CKD in the high-risk group (elderly hospitalized patients), to provide a powerful basis for the early detection of old CKD in the clinic by.3. through the analysis of the clinical characteristics and etiological factors of the elderly CKD, and to guide the early stage of the CKD. Prevention and control, improve the quality of life of patients and prolong the survival time of patients. [Methods] Retrospective analysis of the basic data of hospitalized patients aged from January 1, 2016 to December 31, 2016 in the Department of Nephrology of the First Affiliated Hospital of Kunming Medical University. The exclusion conditions are as follows: (1) the age of 65 years; (2) the medical history is less than 3 months; (3) patients with incomplete data. Fruit]1. was a total of 2198 people, more than 65 years old and 310 people, aged CKD286, 92.26%, aged non CKD24, 7.74%, 192 men, 61.94%, 118 women, 38.06%, and 72.49 + 5.543 years of age. 81 years old and 28 people, accounting for 9.03%, G1, G2, G3a, G3b, G4, G5 were 135, 28, 21, 49, 44 and 9, respectively, in the aged CKD period, respectively, 47.20%, 9.79%, 7.34%, 17.13%, and 3.15%.2. 22 of gout, 7.96%, chronic interstitial nephritis in 8, 4 of connective tissue diseases, 1.40%, 3 of polycystic kidney, 1.05% and 10 in the other 10 people, and the main cause of CKD in 3. 50%. old age was hypertension.3., the main cause was hypertension, less than 69 years of age, 70-75 years, 76-80 years, or more than 81, respectively. 61.54%, 61.54%, 72%; the main causes of CKD in the elderly were hypertension, G1, G2, G3a, G3b, G4, and G5 accounted for 60.74%, 60.71%, 57.14%, 65.31%, 65.91%, 66.67%, 65 in the dialysis patients, 14.68%, and 221 in non dialysis patients, and the elderly CKD group and the elderly non CKD group were found to have no unification. X2=11.849, P=0.001, urinary protein (x2=19.903, P0.001), urinary occult blood (x2=6. 673, P=0. 010) were statistically different. The elderly CKD male (96.35%) was higher than the female (85.59%).5. by t test and found that the elderly CKD group and the elderly non CKD group total cholesterol (t=-1.457, 808), albumin (808), albumin (783)) Statistical difference was found in the elderly CKD group and the elderly non CKD group (t=-6.556, P0.001), red blood cell (t=-4.970, P0.001), uric acid (t=3.323, P=0.001), phosphorus (t=3.805, P=0.001), and the old group of the old group was lower than the old non CKD group. There was no significant difference in triglyceride between the elderly CKD group and the elderly non CKD group (Z=1. 083, P=0.191), and there was a statistical difference between the elderly CKD group and the elderly non CKD group (Z=2. 737, P0.001), creatinine (Z=3.079, P0.001), and cystatin -C (Z=3.064, and cystatin). There were no statistical differences in uric acid (F=1.709, P=0.133), calcium (F=1.684, P=0.138), and albumin (F=2.027, P=0.075) at all stages of CKD group. There were significant differences in hemoglobin (F=42.715, P0.001), red blood cells (F=37.893, P0.001) and phosphorus (001) in the aged CKD group. By the rank sum test analysis of phosphorus from G1 to G4, it was found that there was no statistical difference in the triglyceride (H=5.184, P=0.398) of the aged CKD group (H=5.184, P=0.398) at all stages, and the urea (H=187. 741, P0.001), creatinine (H=248. 711, P0.001) in the old CKD group and the cystatin C (.8.) were statistically different, and the urea, creatinine and cystatin were found from the 22 comparative analysis. From 1 to G5,.9. was gradually increased by statistical analysis, and urea (P=0.00, OR=1. 355, 95C. I.%=1.157-1.585), creatinine (P=0.02, OR=1.011,95C. I.=%1.004-1.108), uric acid (P=0.001, OR=1.007,95C. I., 032), phosphorus (820, 032), red blood cells (032), red blood cells ( P=0.002, OR=0.463,95C. I.%=0. 285-0. 750), hemoglobin (P=0. 001, OR=0. 972, 95C. I.%=0. 957-0. 988), urinary protein A3 level, urinary occult blood (309, 578) =3. 4,95%C.I.=1.687-6. 855) is an early sensitive index for the discovery of old CKD. There is a statistical difference (P=0.001).11. when the critical value of creatinine is 123.80umol/L, its specificity is 0.917, and the sensitivity is 0.738. When the critical value of cystatin -C is 1.88 mg/L, its specificity is 0.875, and the sensitivity is 0.776, which may be the best clinical diagnosis of early renal impairment. A ROC curve for the determination of creatinine and cystatin -C, the area under the creatinine curve was 0.864, the area under the cystatin -C curve was 0.886. It was found that both of them had a high diagnostic value for the elderly CKD, and cystatin -C had a higher diagnostic value than creatinine. This study found that 9 people died of CKD, 3.15% of the elderly, 0 elderly non CKD deaths, and CKD death in the elderly. Among the causes of death, 5 were hypertension, 55.55% were hypertension, 2 were diabetes, 1 were gout, 11.11% were gout, 1 were polycystic kidney, accounting for 11.11%. Among the causes of CKD death, there were 6 of multiple organ failure, 66.67%, 2, 22.22% and pulmonary infection, accounting for 66.67%, pulmonary infection 1, and 11.11%.. The statistical analysis of diabetes, chronic nephritis, gout, chronic interstitial nephritis, connective tissue disease, and polycystic kidney.2. showed that urea, creatinine, uric acid, Cystatin -C, phosphorus, red blood cells, hemoglobin, urine protein, and urine occult blood are the sensitive index of CKD in old age.3., and the ROC curves of creatinine and cystatin -C determination results are found, and they have been found to be high for the elderly CKD. The diagnostic value of cystatin -C was better than creatinine.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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