ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2011, Vol. 20 ›› Issue (3): 218-226.

• 论文 • 上一篇    下一篇

腹膜透析患者长期生存及相关因素分析---单中心登记系统数据分析

  

  • 出版日期:2011-06-30 发布日期:2011-08-08

Long-term survival and relative factors on peritoneal dialysis patients:Data analysis of single center on registration system

  • Online:2011-06-30 Published:2011-08-08

摘要:

目的:分析本中心长期腹膜透析(PD)患者临床数据,探讨当前PD患者的远期预后及相关影响因素。 方法:分析2002年2月至2010年11月30日间登记在册的681例PD患者的临床资料。采用 Kaplan–Meier 方法计算患者存活率及技术生存率,并以多因素COX回归模型计算风险比值(hazard ratios,HR),进一步明确影响预后的独立因素。 结果:男性398例(58.5%),女性283例(41.5%),平均年龄45.68±15.69岁。原发病包括慢性肾炎(74.1%)和糖尿病肾病(11.8%)等。患者平均透程13.94±16.40月,其中白天不卧床腹膜透析(DAPD)604例(88.7%),持续不卧床腹膜透析(CAPD)77例(11.3%)。1、3、5及8年的技术存活率和患者生存率为别为87%、74.4%、61.85%、53%和94.2%、80.8%、75.3%、64.5%。除因经济因素放弃治疗外,近三年导致患者退出PD的主要因素分别是心血管系统并发症(23%~41%)、透析不充分(25%~43%)和腹膜炎(10%~16.7%)。此外,少数患者因导管(6.7%~10.3%)及胸腔积液(0~6.7%)等因素退出。导致患者死亡的主要因素为心血管事件(23%~-41%)、脑血管事件(12.5%~20%)和感染(6.3%~15.4%)。通过单因素COX回归分析显示低血浆白蛋白血症、严重贫血和蛋白质能量代谢异常等与营养不良相关的并发症以及透析不充分是导致PD患者掉队的独立风险因素。 结论:本中心PD患者有较好的生存率和技术生存率,影响PD患者预后的主要因素为心、脑血管并发症及透析不充分。

Abstract:

Objective: To analyze the current situation of peritoneal dialysis in our country and the factors influencing the long-term prognosis by review of single peritoneal dialysis center registration data system.  Methodology:Patients on maintenance PD were retrospectively studied from January 2002 to December 2010. The Kaplan–Meier method for measuring patient survival rate and technique survival rate were applied. We also analyzed the risk factors and calculated their hazard ratio (HR) for patient mortality and PD technique failure using multivariate regression of the Cox proportional hazards method.   Results:A total of 681 patients were recruited. Among them, 398 (58.5%) were males, and the mean age at the start of PD was 45.7±16.4 years old, Chronic glomerulonephritis(CGN)was the main cause of end stage renal disease(ESRD), and followed by diabetes mellitus (11.8%). Mean PD duration was 13.9±16.4 months. There were 604 cases (88.7%) receiving day ambulatory peritoneal dialysis (DAPD), while 77 (11.3%) got continuous ambulatory peritoneal dialysis (CAPD). The 1, 3, 5 and 8 years of technical survival rates were 87.0%, 74.4%, 61.8% and 53.0%, respectively. While the 1, 3, 5 and 8 years of patient survival rates were 94.8%, 78.9%, 70.6% and 48.5%, respectively.Excluded patients giving up treatment due to economic factors,the causes of quit PD were cardiovascular diseases (23%~41%), dialysis inadequacy (25%~43%),peritonitis (10%~16.7%).catheters complications(6.7%-10.3%) and pleural effusion (0-6.7%).The main causes of death were cardiovascular events (23%~41%), cerebrovascular events (12.5%~20%) and infection (6.3%~15.4%).The predictors of patient drop-out in our study were anemia [relative risk (RR) 0.53, p < 0.01], protein energy malnutrition (RR 0.77, p < 0.05),low serum albumin level (RR 9.49, p < 0.01) upon starting PD.  Conclusion:The patients with PD in our center had a good technical survival rate. The main factor influencing the prognosis was cardiovascular diseases and dialysis inadequacy.