影响维持性血液透析患者死亡危险因素分析

张东亮; 王质刚

Abstract

张东亮,王质刚.影响维持性血液透析患者死亡危险因素分析[J].Chinese journal of Epidemiology,2003,24(6):508-511

影响维持性血液透析患者死亡危险因素分析

Study on the mortality-related factors in patients undergoing maintenance hemodialysis

Received:July 20, 2002

DOI：

KeyWord: 血液透析危险因素回顾性队列研究

English Key Word: Hemodialysis Prognostic factors Retrospective cohort study

FundProject:

Author Name	Affiliation
ZHANG Dong-liang	首都医科大学附属北京友谊医院肾内科, 100050
WANG Zhi-gang	首都医科大学附属北京友谊医院肾内科, 100050

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Abstract:

目的探讨维持性血液透析患者死亡的危险因素。方法选择1990年2月至2002年2月原发病为慢性肾小球肾炎在北京友谊医院血液透析中心长期稳定维持性血液透析的患者共107例进行回顾性研究,使用寿命表法进行生存分析,用Cox回归分析找出死亡的预测因素,对Cox回归分析显示有意义的观察项目根据临床目标值大小将患者分成两组,然后通过Gehan法对各因素两组间的生存率进行比较。结果107例维持性血液透析患者在随访期间,共死亡22例(15.3%),存活88例(84.7%),其中5年累积生存率为79.91%,10年累积生存率为64.36%。透析开始时的年龄(P<0.001)、透析前血尿素氮(BUN,P=0.004)、透析前血肌酐(SCr,P=0.001)、钙磷乘积(P=0.019)及尿素清除指数(KT/V,P=0.001)为死亡预测因素,其风险比(HR)分别为:1.107(95%Cl:1.049～1.168)、0.951(95%Cl:0.918～0.984)、0.727(95%Cl:0.599～0.883)、1.025(95%Cl:1.004～1.046)和0.013(95%Cl:0.001～0.161)。各因素两组间存活率差异均有显著性(年龄≥60岁组与<60岁组比较,P=0.0006;BUN≥28.6mmol/L组与<28.6mmol/L组比较,P=0.0415;SCr≥884μmol/L组与<88μmol/L组比较，P=0.014 6;钙磷乘积≥40组与< 40组比较，P=0.046 4; KT/V, 1.30组与< 1.30组比较，P=0.021 5)。结论透析开始时的年龄、维持透析3个月时透析前BUN. SCr、血浆钙磷乘积及KT/V为死亡的预测因素，其中年龄、钙磷乘积为死亡的危险因素，透析前BUN. SCr. KT/V为保护性因素。

English Abstract:

Objective To identify the mortality-related factors in patients undergoing maintenance hemodialysis.Methods One hundred and seven long-term hemodialysis patients having suffered from chronic glomerulonephritis and received hemodialysis treatment in the hemodialysis center of the Friendship Hospital during February 1990 to February 2002 were selected to take part in a retrospective study. Survival analysis was done using Life Tables study. Cox regression analysis was used to find factors related to risk. Patients were divided into two groups according to the clinical value of the factors which showed statistical significance in Cox regression analysis. Survive rates were compared between two groups on Gehan test.Results Among the 107 patients, 22 died (15.3%)and 85 survived (84.7%)during the follow-up period. Cumulative survival rates of 5 years and 10 years were 79.91% and 64.36% respectively. Prognostic factors would include age (P 0.001), blood urea nitrogen (BUN, P=0.004), serum creatinine (SCr, P=0.001), value of plasma calcium multiplied by plasma phosphate (P=0.019), and KT/V (P=0.001), which were all tested during the third dialysis month. The Hazard Ratios (HR) were 1.107 (95% Confidence Interval,95% CI : 1.049- 1.168), 0.951(95% CI : 0.918- 0.984), 0.727(95% CI : 0.599- 0.883), 1.025(95% CI : 1.004- 1.046), and 0.013(95% CI : 0.001- 0.161), respectively. The survival rates between two groups were significant different (age≥60 years group vs 60 years group P=0.000 6, BUN≥ 28.6 mmol/L vs 28.6 mmol/L group P=0.041 5, SCr≥884 μmol/L vs 884 μmol/L group P=0.014 6, value of plasma calcium multiplied by plasma phosphate ≥40 vs 40 group P=0.046 4, KT/V≥ 1.30 vs 1.30 group P=0.021 5).Conclusions The mortality related prognostic factors of maintained hemodialysis patients seemed to include age, BUN, SCr, value of plasma calcium multiplied by plasma phosphate, and KT/V, which were all tested during the third dialysis month. Among them, age and the value of plasma calcium multiplied by plasma phosphate were risk factors of death, while the others were protective factors.

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