老年终末期肾病患者血液透析和腹膜透析的生存预后分析

发布时间：2018-05-29 17:37

  本文选题：老年 + 血液透析　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:了解我国综合性医院老年终末期肾病患者行血液透析和腹膜透析治疗的人群特征,评估他们的生存情况,比较两者的生存差异,探讨影响生存率的相关因素。方法:回顾性分析了本院2008年1月1日至2014年12月31日新进入透析并维持透析治疗≥3个月、年龄≥60岁老年患者,收集他们的人口统计学资料及临床资料,随访至2015年9月30日,应用倾向性评分法匹配出两组患者,然后采用Kaplan□ Meier法、Log-rank检验及Cox回归模型分析患者的生存率及预后的影响因素,期间采用意向治疗分析(intention to treat analysis)和接受治疗分析(as treated analysis)两种方法。结果:1.共纳入患者447例,其中起始HD组236例,起始PD组211例,应用倾向评分匹配法(propensity score method,PSM)匹配成功174对患者,两组患者基线资料比较,包括开始透析时的年龄、性别、Charlson合并症指数(CCI)、原发病、血清肌酐、血红蛋白、血浆白蛋白、铁蛋白、转铁蛋白饱和度、肾小球滤过率(eGFR)、射血分数等差异均无统计学意义(P0.05)。两组患者主要死因均为心、脑血管意外及感染,两组死因比较无显著差异(P0.05)。2.意向治疗分析:Kaplan-Meier生存曲线显示,HD组和PD组1年、5年的存活率分别为93.6%、63.4%和91.9%、61.5%,两组总体生存率差异无统计学意义(P0.05)。HD80岁组生存率明显高于HD≥80岁组,差异有统计学意义(Log-rank检验,P=0.015);糖尿病肾病HD组生存率明显低于非糖尿病肾病HD组,差异有统计学意义(Log-rank检验,P=0.032);开始透析时CCI5HD组生存率明显高于CCI≥5HD组(Log-rank检验,P=0.016)。根据以上的3种分层结果发现,PD组组内及HD组和PD组组间比较,生存率差异均无统计学意义(Log-rank检验,P0.05)。Cox多因素回归分析显示,高龄(≥80岁)(P0.001,HR=1.058,95%CI 1.028～1.088)、原发病为糖尿病肾病(P=0.001,HR=2.161,95%CI 1.384～3.373)、开始透析时 CCI≥5(P=0.007,HR=1.935,95%CI 1.201～3.117)显著影响HD患者的生存率;高龄(≥80岁)(P=0.022,HR=1.043,95%CI 1.006～1.081)、血浆白蛋白35 g/L(P=0.025,HR=1.776,95%CI 1.075～2.934)、前白蛋白30 g/L(P=0.012,HR=0.968,95%CI 0.944～0.993)显著影响PD患者的生存率。3.接受治疗分析结果与意向治疗分析结果基本一致。结论:1.≥60岁的老年HD组与PD组总体生存率差异无统计学意义;2.HD80岁组生存率明显高于HD≥80岁组;糖尿病肾病HD组生存率明显低于非糖尿病肾病HD组;开始透析时CCI5 HD组生存率明显高于CCI≥5 HD组。3.高龄、原发病为糖尿病肾病、开始透析时CCI≥5是老年HD患者生存率的独立影响因素;高龄、血浆白蛋白35 g/L、前白蛋白30g/L是老年PD患者生存率的独立影响因素。
[Abstract]:Objective: to investigate the population characteristics of elderly end-stage nephropathy patients undergoing hemodialysis and peritoneal dialysis in Chinese general hospitals, to evaluate their survival status, to compare their survival differences, and to explore the related factors affecting survival rate. Methods: from January 1, 2008 to December 31, 2014, the elderly patients aged more than 60 years, who entered dialysis and maintained dialysis treatment for more than 3 months, were analyzed retrospectively, and their demographic data and clinical data were collected. The patients were followed up until September 30, 2015. The two groups were matched by tendentiousness score, and then the survival rate and prognostic factors were analyzed by Kaplan-Meier method with Log-rank test and Cox regression model. Intention to treat analysis) and treatment analysis as treated analysis were used. The result is 1: 1. A total of 447 patients were included, including 236 patients in HD group and 211 patients in PD group. 174 pairs of patients were matched successfully by propensity score method. Baseline data of the two groups were compared, including age at the time of dialysis. Sex Charlson complication index (CCI), primary disease, serum creatinine, hemoglobin, plasma albumin, ferritin, transferrin saturation, glomerular filtration rate (GFR) and ejection fraction were not significantly different (P 0.05). The main causes of death in the two groups were heart, cerebrovascular accident and infection. There was no significant difference in the cause of death between the two groups (P0.055.2.) The 1 year survival rate of HD group and PD group were 93.63.4% and 91.9%, respectively. There was no significant difference in overall survival rate between the two groups. The survival rate of HD group was significantly higher than that of HD 鈮，

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