摘要
【目的】探讨维持性血液透析(MHD)患者死亡的的主要原因及影响死亡的危险因素。【方法】采用回顾性研究,纳入210例中山大学附属第三医院维持性血液透析患者,死亡的68例为观察组,存活的142例患者为对照组,采用单因素及二分类Logistic回归方法分析各临床指标对患者预后的影响。对死亡患者还进行亚组分析,比较心血管死亡患者和非心血管死亡患者心脏彩超数据。【结果】患者年龄(56.6±16.6)岁,其中男性患者125人。与对照组相比,死亡组患者年龄更大,并发高血压、糖尿病、心脑血管疾病的比例更高,血红蛋白、白蛋白、血肌酐及血尿酸水平更低,而超敏C反应蛋白水平则明显升高(P值均<0.05)。68例死亡患者中,死亡前3位原因分别是心脑血管疾病(33例,48.5%)、感染(16例,23.5%)、营养不良性衰竭(8例,11.8%)。Logistic回归分析显示年龄、合并心脑血管疾病、糖尿病、超敏C反应蛋白及血肌酐水平是MHD患者死亡的独立危险因素。亚组分析显示,与非心脑血管疾病死亡组患者心脏彩超结果相比,心脑血管疾病死亡组患者左心室肥厚和瓣膜钙化的发生率更高。【结论】心脑血管疾病、感染、营养不良是维持性血液透析患者死亡的主要原因,心血管死亡患者伴发左心室肥厚及瓣膜钙化的比例显著高于非心血管死亡患者。
【Objective】To explore the main causes of death and the risk factors for death in maintenance hemodialysis(MHD)patients.【Methods】A retrospective study was carried out in 210 MHD patients in The Third Affiliated Hospital of Sun Yat-sen University.Of the 210 patients,68 dead were designated as the experimental group and the other 142 survivals as the control.Single factor and binary logistic regression analyses were used to investigate the effects of clinical indicators on the prognosis of patients.We further performed subgroup analysis in experimental group,examined the patients died of cardiovascular diseases and those died of non-cardiovascular diseases,and then compared their results of color Doppler echocardiography.【Results】The age of the patients was(56.6±16.6)years and 125 of them were male.Compared with those in the control group,the patients in the death group had elder average age,higher rates of complications such as hypertension,diabetes,cardio-cerebro-vascular diseases,lower levels of hemoglobin,albumin,creatinine and uric acid and significantly elevated level of hypersensitive C-reactive protein(P<0.05).The top three causes of death were cardiocerebro-vascular disease(33 cases,48.5%),infection(16 cases,23.5%),malnutrition(8 cases,11.8%).Logistic regression analysis showed that age,cardio-cerebro-vascular diseases,diabetes mellitus,hypersensitive C-reactive protein and serum creatinine were independent risk factors for death in MHD patients.Subgroup analysis revealed the patients died of CVD diseases had higher incidences of left ventricular hypertrophy and cardiac valve calcification than those died of non-CVD diseases.【Conclusion】Cardio-cerebro-vascular diseases,infection and malnutrition are the main causes of death in MHD patients.Patients died of CVD diseases exhibit significantly higher incidences of left ven⁃tricular hypertrophy and cardiac valve calcification compared with those died of non-CVD diseases.
作者
李明
李灿明
叶增纯
赵文波
唐骅
刘迅
彭晖
娄探奇
LI Ming;LI Can-ming;YE Zeng-chun;ZHAO Wen-bo;TANG Hua;LIU Xun;PENG Hui;LOU Tan-qi(Department of Nephrology,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2020年第4期620-626,共7页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省医学科研基金(A2017325)。
关键词
血液透析
死亡
心血管疾病
危险因素
hemodialysis
death
cardiovascular disease
risk factors
作者简介
李明,主治医师,研究方向:急性肾损伤及血液净化,E-mail:ming81918@163.com;通信作者:彭晖,教授,E-mail:eliza⁃peng01@hotmail.com。
