摘要
目的:探讨维持性血液透析患者死亡原因及导致死亡的危险因素。方法:选取2011年1月—2016年12月于我院血液净化中心行维持性血液透析死亡患者66例,记录患者开始透析治疗时的一般资料及死亡前1年的透析相关指标和实验室指标,采用COX比例风险回归分析患者死亡的危险因素。结果:66例维持性血液透析死亡患者的原发疾病中,糖尿病肾病28例(42.4%),慢性肾小球肾炎21例(31.8%),高血压肾病7例(10.6%),其他10例(15.2%);死亡原因中心脑血管疾病38例(57.57%),感染18例(27.3%),癌症7例(10.6%),其他3例(4.54%)。单因素COX回归分析提示透始年龄、透前合并心脑血管疾病、透前合并恶性肿瘤、透前合并糖尿病、血红蛋白、血白蛋白、低密度脂蛋白、血磷是维持性血液透析患者死亡的影响因素。多因素COX回归分析提示透始高龄(HR=1.042,95%CI:1.008~1.076,P=0.014)、透前合并恶性肿瘤(HR=2.709,95%CI:1.243~5.903,P=0.012)、高血磷(HR=2.598,95%CI:1.488~4.536,P=0.001)、血红蛋白降低(HR=0.982,95%CI:0.967~0.998,P=0.031)及低密度脂蛋白升高(HR=1.429,95%CI:1.099~1.857,P=0.008)是维持性血液透析患者死亡的主要危险因素。结论:心脑血管疾病是导致维持性血液透析患者死亡最主要的原因。透始高龄、透前合并恶性肿瘤、高血磷、血红蛋白降低及低密度脂蛋白升高是维持性血液透析患者死亡的独立危险因素。
Objective:To investigate the cause and risk factors of death in maintenance hemodialysis patients.Methods:The subjects of this study were 66 patients who underwent hemodialysis during January 2011 to December 2016 in our hematology purification center and had received hemodialysis for at least 3 months.The general data of the patients when started dialysis treatment and the dialysis related indexes and laboratory indexes before 1 year of death were recorded.The risk factors of death were analyzed by COX proportional hazards regression.Results:In the 66 death cases,there were 28 cases of diabetic nephropathy(42.4%),21 cases of chronic glomerulonephritis(31.8%),7 cases of hypertensive nephropathy(10.6%),and the other 10 cases(15.2%).The causes of death included cardiovascular and cerebrovascular diseases in 38 cases(57.57%),infection in 18 cases(27.3%),cancer in 7 cases(10.6%),and other 3 cases(4.54%).Univariate COX regression model showed that older age at the start of dialysis therapy,history of cardiovascular and cerebrovascular diseases before dialysis,history of cancel before dialysis,history of diabetes,hemoglobin,serum albumin,LDL,serum phosphorus were influencing factors of death in patients with maintenance hemodialysis.Multivariate COX regression model revealed that older age at the start of dialysis therapy(HR=1.042,95%CI:1.008~1.076,P=0.014),history of cancel before dialysis(HR=2.709,95%CI:1.243~5.903,P=0.012),high serum phosphate(HR=2.598,95%CI:1.488~4.536,P=0.001),lower hemoglobin(HR=0.982,95%CI:0.967~0.998,P=0.031)and increased LDL(HR=1.429,95%CI:1.099~1.857,P=0.008)were the mian risk factors associated with the survival rates in maintenance hemodialysis patients.Conclusion:Cardiovascular and cerebrovascular diseases were the main cause of death in maintenance hemodialysis patients.Older age at the start of dialysis therapy,history of cancel before dialysis,high serum phosphate,lower hemoglobin,and increased LDL may be the main risk factors for survival of maintenance hemodialysis patients.
作者
曹霞
叶婧
吕天羽
王玉新
CAO Xia;YE Jing;LV Tianyu(Department of Nephrology,the Second Affiliated Hospital of Xiamen Medical College,Xiamen City,Fujian Province 361021)
出处
《医学理论与实践》
2019年第21期3410-3412,3425,共4页
The Journal of Medical Theory and Practice
作者简介
通讯作者:王玉新。
