维持性血液透析患者死亡风险因素分析

发布时间：2018-05-30 22:19

  本文选题：终末期肾脏病 + 血液透析　； 参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：背景:维持性血液透析(maintenance hemodialysis, MHD)是治疗终末期肾脏病的重要方法之一,尽管血液透析水平在不断提高,MHD患者的死亡风险与普通人群相比仍然较高。因此,了解MHD患者死亡风险因素十分重要。MHD患者的生存期从数月到数十年不等,不同生存期的MHD患者死亡风险因素是否相同尚未得到深入研究。此外,有研究发现,MHD患者在死亡之前有一定的临床特点,而我国关于MHD患者死亡之前临床特点及其与死亡的相关性研究较少。因此,本研究旨在分析MHD患者不同生存期死亡风险因素的异同,及MHD患者死亡之前的临床特点及其与死亡的相关性。方法:本研究共两部分,第一部分将解放军总医院2004-2014年新进入血液透析并且符合入选标准的患者作为研究对象,收集其基线数据,并随访至2015年12月31日,使用COX回归分析分别探讨MHD患者3-12个月、13-36个月、37-60个月、61-144个月各生存期死亡风险因素,从而了解MHD患者不同生存期死亡风险因素的异同;第二部分将我国16家血液净化中心2012-2014年的MHD患者作为研究对象,将死亡患者死亡前与存活患者研究结束之前的临床特征进行比较,并通过Logistic回归分析死亡相关因素,从而了解MHD患者死亡之前临床特点及死亡相关影响因素。结果:第一部分研究共纳入392名患者,多因素COX回归分析显示,MHD患者3-12个月的死亡风险因素为低水平血清白蛋白(HR=0.849, 95%CI:0.750-0.962); 13-36 个月的死亡风险因素为增龄(HR=1.057, 95%CI: 1.021-1.095)及糖尿病肾病(HR=2.959, 95%CI: 1.239-7.070),血清白蛋白水平较高(HR=0.909,95%CI: 0.831-0.993)及甘油三酯≥1.7 mmol/L (HR=0.209, 95%CI: 0.080-0.543)的患者死亡风险较低;患者37-60个月及61-144个月的死亡风险均为增龄(37-60个月 HR=1.064, 95%CI: 1.021-1.110, 61-144 个月 HR=1.096, 95%CI: 1.041-1.153)。第二部分共纳入4104名患者,与存活组患者相比,死亡组患者中男性、糖尿病肾病及高血压肾损害患者所占比例较高,同时,死亡组患者具有较低的透析前舒张压、血红蛋白、血清白蛋白、血钙、血磷、spKt/V水平及较高的年龄。Logistic回归分析显示,男性(OR=1.437, 95% CI: 1.094-1.886)、增龄(OR=1.046, 95% CI:1.036-1.057)、原发疾病为糖尿病肾病(OR=1.837, 95% CI: 1.322-2.552)、低水平血钙(OR=0.585, 95% CI: 0.346-0.989)、低水平血红蛋白(OR=0.974, 95% CI:0.967-0.981)和低水平血清白蛋白(OR=0.939, 95% CI: 0.915-0.963)是死亡相关危险因素。结论:不同生存期的MHD患者死亡风险因素并不相同,同时MHD患者死亡之前具有一定的临床特征,了解患者在不同生存期的死亡风险因素有助于对患者的预后进行判断及有效干预。
[Abstract]:Background: maintenance hemodialysis (MHD) is one of the most important methods for the treatment of end-stage renal disease, although the risk of death of MHD patients is still higher than that of the general population. Therefore, it is very important to understand the death risk factors of MHD patients. The survival time of MHD patients varies from months to decades. Whether the death risk factors of MHD patients with different survival periods are the same has not been further studied. In addition, some studies have found that MHD patients have certain clinical characteristics before death, but there are few studies on the clinical characteristics and their correlation with death in MHD patients in China. Therefore, the purpose of this study was to analyze the differences and similarities of death risk factors in MHD patients with different survival periods, and to analyze the clinical features of MHD patients before death and their correlation with death. Methods: this study consists of two parts. In the first part, the patients newly entered hemodialysis in PLA General Hospital from 2004 to 2014 and who met the inclusion criteria were selected as the study subjects, and their baseline data were collected and followed up until December 31, 2015. COX regression analysis was used to study the risk factors of death in patients with MHD from 3-12 months to 13-36 months and from 37-60 months to 61-144 months, so as to understand the similarities and differences of death risk factors among different survival periods in patients with MHD. In the second part, the MHD patients from 16 blood purification centers in China from 2012 to 2014 were studied. The clinical characteristics of the dead patients before death and those of the surviving patients were compared, and the factors related to death were analyzed by Logistic regression analysis. In order to understand the clinical characteristics of MHD patients before death and death related factors. Results: the first part of the study involved 392 patients. Multivariate COX regression analysis showed that the risk factors for death in patients with MHD for 3-12 months were low serum albumin (HR0.849), 95 CI: 0.750-0.962U, 13-36 months mortality risk factors (HR1.057, 95CI: 1.021-1.095) and diabetic nephropathy (HR2.959, 95CI1.239-7.0707), the serum albumin level was higher than 0.90995 CI: 0.831-993) Patients with triglyceride 鈮，

本文编号：1957057