无尿的血液透析和腹膜透析患者的临床特征及预后分析

发布时间：2018-05-14 13:34

本文选题：腹膜透析 + 血液透析　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的:比较无尿的维持性血液透析(maintenance hemodialysis,MHD)及持续不卧床腹膜透析(Continuous Ambulatory peritoneal dialysis,CAPD)患者的临床特征及预后,为无尿的透析患者的治疗提供参考依据。方法:回顾性纳入2008年1月至2015年12月在宁夏医科大学总医院肾脏内科规律行透析治疗(MHD和CAPD)且已无尿(每日尿量100ml)的患者。收集研究对象的一般资料、生化指标及转归情况等。比较两组患者在发生无尿时的临床特征,应用Kaplan-Meier法及Cox回归模型分析患者的生存及相关危险因素。研究终点为:主要终点(全因死亡)。结果:1、共纳入234例患者进入本次研究,其中CAPD组患者共152例,男性85例(55.9%),女性67例(44.1%),MHD组患者共82例,男性60例(73.2%),女性22例(26.8%)。两组患者原发病构成均以慢性肾小球肾炎居多,其次为糖尿病肾病、高血压肾损害等,其中CAPD组患者高血压肾损害所占比例高于MHD组(χ2=5.66,P=0.017)。2、临床资料比较:CAPD组患者发生无尿时透析龄、发生无尿后随访时间、BMI、总Kt/V、血钙、肌酐水平均高于MHD组(P0.05)。CAPD组患者身高、血磷、血清白蛋白、血钾水平低于MHD组(P0.05)。无尿的CAPD组与MHD组患者发生无尿时的年龄、收缩压、舒张压、体重、白细胞、血红蛋白、iPTH、血清铁、甘油三酯、总胆固醇、低密度脂蛋白、高密度脂蛋白、血糖、血钠、二氧化碳结合力、超敏C反应蛋白水平无明显差异(P0.05);3、截止研究终点共死亡人数67例(28.6%),其中CAPD组40例,死亡原因主要为心血管事件14例(35%),全因死亡6例(15%),腹膜炎6例(15%)、脑血管事件6例(15%)、感染4例(10%)、营养不良3例(7.5%)。MHD组总死亡人数27例,死亡原因主要为心血管事件10例(37.04%),全因死亡8例(29.6%),脑血管事件6例(22.2%),感染3例(11.1%)。两组间患者心血管事件、脑血管事件、全因死亡、感染引起的死亡率无差异(P0.05);CAPD组患者腹膜炎引起的死亡率明显高于MHD组患者(P0.05)。4、CAPD组患者发生无尿后平均生存时间为(23.29±23.58)月,MHD组患者发生无尿后平均生存时间为(12.26±10.39)月,CAPD组发生无尿后生存时间长于MHD组患者(P0.05);CAPD组患者无尿后生存率高于MHD组(P0.05);5、经多因素Cox回归分析显示:年龄、血浆白蛋白、血糖、超敏C反应蛋白是影响无尿的CAPD患者生存时间的危险因素(P=0.000),年龄、收缩压是影响无尿的MHD组患者生存率的危险因素(P=0.000)。结论:1、MHD组患者较CAPD组发生无尿的时间更早;而发生无尿后CAPD患者生存率较MHD高;2、年龄、血浆白蛋白、血糖、超敏C反应蛋白是影响无尿CAPD患者生存率的危险因素,年龄、收缩压是影响无尿的MHD患者生存率的危险因素。
[Abstract]:Objective: to compare the clinical features and prognosis of maintenance hemodialysis (HD) patients with anuria and continuous Ambulatory peritoneal dialysis (CAD) with continuous ambulatory peritoneal dialysis (PD), so as to provide reference for the treatment of patients with anuria. Methods: from January 2008 to December 2015, the patients with MHD and CAPDwere treated with dialysis from January 2008 to December 2015 in the Department of Renal Medicine, Ningxia Medical University General Hospital and had no urine (100 ml per day). Collect the general data, biochemical indicators and the outcome of the study. The clinical characteristics of patients with anuria were compared and the survival and related risk factors were analyzed by Kaplan-Meier method and Cox regression model. The end point of the study was: main end point (all cause of death). Results two hundred and twenty four patients were included in the study, including 152 patients in the CAPD group, 85 in the male group, 82 in the female group, 60 in the male group and 22 in the female group. The primary components of the two groups were mainly chronic glomerulonephritis, followed by diabetic nephropathy, hypertensive renal damage and so on. The proportion of hypertensive renal damage in CAPD group was higher than that in MHD group (蠂 2 = 5.66). The clinical data were compared with that in MHD group (P 0.05. 05). The clinical data were compared with those in MHD group. The age of dialysis, follow-up time after anuria, total KT / V, serum calcium and creatinine levels were all higher than those in MHD group P0.05.CAPD group. The levels of serum albumin and potassium were lower than those of MHD group (P 0.05). Age, systolic blood pressure, diastolic blood pressure, body weight, white blood cell, hemoglobin CAPD, serum iron, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein, blood glucose, blood sodium, There was no significant difference in carbon dioxide binding capacity and hypersensitive C-reactive protein level (P 0.05). At the end of the study, 67 patients died, including 40 patients in CAPD group. The main causes of death were cardiovascular events in 14 cases, total death in 6 cases, peritonitis in 6 cases, cerebrovascular events in 6 cases, infection in 4 cases and malnutrition in 3 cases. The total number of deaths in MHD group was 27 cases. The main causes of death were cardiovascular events in 10 cases (37. 04), death in 8 cases (29. 6%), cerebrovascular events in 6 cases (22. 2%) and infection in 3 cases (11. 1%). Between the two groups, cardiovascular events, cerebrovascular events, all due to death, There was no difference in mortality caused by infection. The mortality caused by peritonitis in patients with CAPD was significantly higher than that in patients with MHD. The mean survival time after anuria was 23.29 卤23.58. The mean survival time of patients with CAPD was 12.26 卤10.39 months. The survival time after anuria was longer than that in MHD group (P 0.05) and the survival rate was higher than that in MHD group (P 0.05). The age was analyzed by multivariate Cox regression analysis. Plasma albumin, blood glucose and hypersensitive C-reactive protein were the risk factors of survival time in patients with CAPD with anuria. Age and systolic blood pressure were the risk factors for survival of patients with anuria MHD. Conclusion the duration of anuria in CAPD group was earlier than that in CAPD group, and the survival rate of CAPD patients after anuria was 2% higher than that of MHD. Age, plasma albumin, blood glucose and hypersensitive C-reactive protein were the risk factors affecting the survival rate of CAPD patients with anuria. Systolic blood pressure is a risk factor for survival in MHD patients with anuria.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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