合并心血管疾病的终末期肾病透析患者的死亡率及死亡危险因素分析

发布时间：2018-04-19 02:13

本文选题：心血管疾病 + 透析方式　；参考：《南方医科大学》2017年硕士论文

【摘要】：目的:探讨合并心血管疾病的终末期肾病透析患者的死亡率及死亡危险因素。同时探讨该研究人群中不同透析方式之间的死亡风险差异,探讨合并心血管疾病的透析患者选择何种透析方式具有更高的生存率。方法:前瞻性队列研究。本研究共纳入2009年5月一2014年5月来自广州军区总医院及广州市第一人民医院的共591例透析患者。根据入组时有无合并心血管疾病分为合并心血管疾病组及无合并心血管疾病组。同时根据透析方式的不同分为血液透析组和腹膜透析组。通过采集基线人口统计学资料(包括年龄、性别、体质指数、透析时程),合并症(包括糖尿病、高血压、脑卒中),实验室指标包括(血红蛋白、血清白蛋白、糖化血红蛋白、高敏C反应蛋白、血清钙磷浓度、校正钙、钙磷乘积、Kt/V、尿酸、甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白)。采用Cox比例风险模型进行单因素及多因素分析合并心血管疾病的终末期肾病透析患者的死亡风险差异及死亡危险因素。同时也探讨不同透析方式之间的死亡风险差异。结果:本研究共纳入终末期肾病透析患者共591例。其中合并心血管疾病的患者有123例,无心血管疾病的患者有468例。同时根据透析方式的不同,分为血液透析组和腹膜透析组。其中血液透析组有285例,腹膜透析组有306例。研究表明,在总人群中,合并心血管疾病的透析患者死亡率要高于无合并心血管疾病的透析患者(HR=2.893,95%CI:1.804-4.693,P＜0.001)。其中在血液透析组中,合并心血管疾病的患者较无合并心血管疾病的患者有着更高的死亡率(HR=4.072,95%CI:2.036-8.142,P0.001)。在腹膜透析组中,合并心血管疾病的患者也较无合并心血管疾病的患者有着更高的死亡率(HR=3.083,95%CI:1.845-7.843,P0.001)。根据不同透析方式的研究结果表明,在合并心血管疾病患者中,血液透析组较腹膜透析组有着更高的死亡率(HR=1.569,95%CI:1.032-2.392,P0.001)。同样地,在无合并心血管疾病患者中,也有相同的结论(HR=1.218,95%CI:1.109-1.348,P0.001)。在心血管疾病组中,以年龄、脑卒中、校正钙、钙、HbAlc等有意义的单因素指标进行多因素分析,结果显示脑卒中(HR=3.802,95%CI:1.752-8.252,P=0.001)为心血管疾病组的独立死亡危险因素。在无合并心血管疾病组中,以年龄、糖尿病、脑卒中、血红蛋白、Hs-CRP、HbAlc、胆固醇、HDL-C等有意义的单因素指标进行多因素分析,结果显示糖尿病(HR=2.974,95%CI:1.560-5.668,P=0.001)及 hs-CRP(HR=1.107,95%CI:1.005-1.030,P=0.005)升高为无心血管疾病组的独立死亡危险因素。而在不同透析方式的研究中,多因素研究表明心血管疾病(HR=3.270,95%CI:1.573-6.798,P=0.002)、脑卒中(HR=2.479,95%CI:1.034-5.945,P=0.042)、Kt/V(HR=2.433,95%CI:1.610-3.676,P0.001)是血液透析组的死亡危险因素。年龄(HR=1.063,95%CI:1.032-1.096,P0.001)、脑卒中(HR=3.980,95%CI:1.781-8.891,P=0.001)及低血红蛋白(HR=0.966,95%CI:0.945-0.987,P=0.002)是腹膜透析组的死亡危险因素。本研究表明,无论选择何种透析方式,合并心血管疾病的透析患者的死亡率均高于无合并心血管疾病的透析患者。而无论有无合并心血管疾病,腹膜透析组的生存率均高于血液透析组。差异具有统计学意义。结论:合并心血管疾病的透析患者死亡率高于无合并心血管疾病的透析患者,且脑卒中是合并心血管疾病的透析患者的死亡独立危险因素。合并心血管疾病的透析患者选择腹膜透析较血液透析具有更高的生存率。
[Abstract]:Objective: To investigate cardiovascular disease in patients with ESRD dialysis mortality and death risk factors. At the same time to investigate the death risk differences between different dialysis methods in the study population, to investigate cardiovascular disease in dialysis patients the choice of dialysis has a higher survival rate. Methods: a prospective cohort study. The study included a total of 591 cases of dialysis patients in May 2009 May 2014 from General Hospita of Guangzhou Military Region and Guangzhou No.1 People's Hospital. According to the group without cardiovascular disease is divided into groups of patients with cardiovascular disease and combined cardiovascular disease group. At the same time according to different dialysis modalities for the group of hemodialysis and peritoneal dialysis. By collecting baseline demographic data (including age, gender, body mass index, dialysis duration), complications (including diabetes, hypertension, stroke), laboratory index package (including hemoglobin, serum albumin, hemoglobin, high sensitive C reactive protein, serum calcium and phosphorus concentrations, correction of calcium, calcium phosphorus product, Kt/V, uric acid, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein). Cox proportional hazards model was used for single factor and multiple factors analysis with cardiovascular disease end patients with ESRD dialysis the difference of the risk of death and death risk factors. It also explores the death risk differences between different dialysis methods. Results: the study included patients with ESRD dialysis. A total of 591 cases with cardiovascular diseases in 123 patients without cardiovascular disease in patients with 468 cases. At the same time, the way of dialysis the different, divided into the group of hemodialysis and peritoneal dialysis. The hemodialysis group had 285 cases, peritoneal dialysis group had 306 cases. The results show that in the general population, death and cardiovascular disease in hemodialysis patients The rate is higher than that of non dialysis patients with cardiovascular disease (HR=2.893,95%CI:1.804-4.693, P < 0.001). In the hemodialysis group, with cardiovascular disease patients than in patients without cardiovascular disease patients have a higher mortality rate (HR=4.072,95%CI:2.036-8.142, P0.001). In the peritoneal dialysis group, patients with cardiovascular disease are more complicated cardiovascular disease patients have a higher mortality rate (HR=3.083,95%CI:1.845-7.843, P0.001). According to a study of different dialysis methods results in patients with cardiovascular disease in hemodialysis group than in peritoneal dialysis patients had a higher mortality rate (HR=1.569,95%CI:1.032-2.392, P0.001). Similarly, in the absence of cardiovascular disease in patients with the same conclusion (HR=1.218,95%CI:1.109-1.348, P0.001). In the cardiovascular disease group, with age, stroke, correction of calcium, calcium, and other significant HbAlc The single factor analysis of multiple factors showed that stroke (HR=3.802,95%CI:1.752-8.252, P=0.001) for cardiovascular disease were independent risk factors of death. In patients with cardiovascular disease group, with age, diabetes, stroke, hemoglobin, Hs-CRP, HbAlc, cholesterol, single index significant HDL-C multi factor analysis the results showed that diabetes, (HR=2.974,95%CI:1.560-5.668, P=0.001) and hs-CRP (HR=1.107,95%CI:1.005-1.030, P=0.005) increased independent risk factors of death for cardiovascular disease group. In different dialysis methods study, multivariate studies show that cardiovascular disease (HR=3.270,95%CI:1.573-6.798, P=0.002), stroke (HR=2.479,95%CI:1.034-5.945, P=0.042), Kt/V (HR=2.433,95%CI:1.610-3.676, P0.001) is the risk factors of death in hemodialysis group. Age (HR=1.063,95%CI:1.032-1.096, P0.001), stroke In (HR=3.980,95%CI:1.781-8.891, P=0.001) and low hemoglobin (HR=0.966,95%CI:0.945-0.987, P=0.002) were risk factors of death in peritoneal dialysis group. This study shows that, regardless of the choice of dialysis, and cardiovascular disease mortality in dialysis patients were higher than that of the patients without cardiovascular disease in dialysis patients. With or without cardiovascular disease, the survival rate of peritoneal dialysis. Were higher than the hemodialysis group. The difference was statistically significant. Conclusion: the mortality of patients with cardiovascular disease in dialysis than those without cardiovascular disease in dialysis patients, and stroke are the independent risk factors of death in dialysis patients with cardiovascular disease. Cardiovascular disease in dialysis patients with peritoneal dialysis hemodialysis has a higher survival rate.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R54

【参考文献】