發(fā)布時間：2018-05-13 00:31

  本文選題：老年 + 慢性腎臟病�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]1.分析老年慢性腎臟病(Chronic Kidney Disease,CKD)的臨床特點,為老年CKD的診斷、治療提供幫助。2.明確高危人群(老年住院患者)中CKD的病因,為臨床提早發(fā)現(xiàn)老年CKD提供有力依據(jù)。3.通過分析老年CKD的臨床特點及病因,指導(dǎo)老年CKD的早期防治,提高患者生活質(zhì)量,延長患者的生存時間。[方法]回顧性分析昆明醫(yī)科大學(xué)第一附屬醫(yī)院腎內(nèi)科2016年1月1日至2016年12月31日收治的年齡≥65歲住院患者基本資料。排除條件如下:①年齡65歲;②病史小于3個月;③資料不全的患者。[結(jié)果]1.本次共計調(diào)查2198人,≥65歲310人,老年CKD286人,占92. 26%,老年非CKD24人,占7. 74%;男性192人,占61.94%,女性118人,占38. 06%,平均年齡為72. 49±5. 543歲;各年齡段中,分別為≤69歲115人,占37. 10%,70-75 歲 109 人,分別占 35.16%, 76-80 歲 58 人,占 18. 71%,≥81 歲 28 人,占9.03%;老年CKD各期中,G1、G2、G3a、G3b、G4、G5分別為135人、28人、21 人、49 人、44 人、9 人,分別占 47. 20%、9. 79%、7. 34%、17. 13%、15. 38%、3.15%。2.本次調(diào)查研究發(fā)現(xiàn),老年CKD的病因中,高血壓178人,占62. 24%、糖尿病36人,占12. 59%、慢性腎炎25人,占8. 74%、痛風(fēng)22人,占7. 96%、慢性間質(zhì)性腎炎8人,占2. 8%,結(jié)締組織病4人,占1.40%、多囊腎3人,占1.05%、其他10人,占3. 50%。老年CKD的主要病因是高血壓。3.本次調(diào)查研究發(fā)現(xiàn),老年CKD各年齡段中主要病因是高血壓,≤69歲、70-75 歲、76-80 歲、≥81 歲分別占 60. 95%、61.54%、61.54%、72.00%;老年CKD各期中主要病因是高血壓,G1、G2、G3a、G3b、G4、G5分別占60. 74%、60. 71%、57.14%、65. 31%、65. 91%、66. 67%;透析患者 65 人,占 14. 68%,非透析患者 221人,占 77. 27%。4.經(jīng)x2檢驗分析發(fā)現(xiàn),老年CKD組與老年非CKD組中,年齡(x 2=2. 562,P=0.464)無統(tǒng)計學(xué)差異;性別(x2=11.849,P=0.001)、尿蛋白(x2=19.903,P0.001)、尿潛血(x2=6. 673,P=0. 010)有統(tǒng)計學(xué)差異。老年CKD男性(96.35%)高于女性(85. 59%) 。5.經(jīng)t檢驗分析發(fā)現(xiàn),老年CKD組與老年非CKD組總膽固醇(t=-1.457,P=0.146)、鈣(t=0.244,P=0. 808)、白蛋白(t=0.275,P=). 783)無統(tǒng)計學(xué)差異;老年CKD組與老年非CKD組血紅蛋白(t=-6.556, P0.001)、紅細胞(t=-4.970, P0.001)、尿酸(t=3.323,P=0.001)、磷(t=3.805, P=0.001)有統(tǒng)計學(xué)差異,老年CKD組血紅蛋白、紅細胞低于老年非CKD組;老年CKD組尿酸、磷高于老年非CKD組。6.經(jīng)秩和檢驗分析發(fā)現(xiàn),老年CKD組與老年非CKD組甘油三酯無統(tǒng)計學(xué)差異(Z=1. 083, P=0.191);老年 CKD 組與老年非 CKD 組尿素(Z=2. 737, P0.001)、肌酐(Z=3.079, P0.001)、胱抑素-C (Z=3.064, P0.001)有統(tǒng)計學(xué)差異;老年CKD組尿素、肌酐、胱抑素-C高于老年非CKD組。7.經(jīng)方差分析發(fā)現(xiàn),老年CKD組各期的尿酸(F=1.709,P=0.133)、鈣(F=1.684,P=0.138)、白蛋白(F=2.027, P=0.075)無統(tǒng)計學(xué)差異;老年 CKD組各期血紅蛋白(F=42.715, P0.001)、紅細胞(F=37.893,P0.001)、磷(F=31.121,P0. 001)有統(tǒng)計學(xué)差異;經(jīng)兩兩比較分析發(fā)現(xiàn),血紅蛋白、紅細胞從G1到G3b逐漸下降,磷從G1到G4逐漸升高。8.經(jīng)秩和檢驗分析發(fā)現(xiàn),老年CKD組各期甘油三酯(H=5.184,P=0.398)無統(tǒng)計學(xué)差異;老年CKD組各期尿素(H=187. 741,P0.001)、肌酐(H=248. 711,P0.001)、胱抑素C (H=200.387, P0.001)有統(tǒng)計學(xué)差異;經(jīng)兩兩比較分析發(fā)現(xiàn),尿素、肌酐、胱抑素-C從G1到G5逐漸升高。9.經(jīng)統(tǒng)計分析發(fā)現(xiàn),尿素(P=0.00,OR=1. 355, 95C. I.%=1.157-1.585)、肌酐(P=0.02, OR=1.011,95C. I.=%1.004-1.108)、尿酸(P=0.001,OR=1.007,95C. I. =%1.003-1. 011)、胱抑素-C(P0.001, OR=4. 765, 95C. I. %=2. 304-9.851)、磷(P=0.019, OR=4. 820, 95C. I. %=1. 289-18. 032)、紅細胞(P=0.002, OR=0.463,95C. I. %=0. 285-0. 750)、血紅蛋白(P=0. 001, OR=0. 972, 95C. I. %=0. 957-0. 988)、尿蛋白A3級(P=0.014, OR=3.404,95C.I.=1.282-9.037)、尿潛血(P=0.014,OR=3. 309, 95C.I. =1.276-8. 578)為老年CKD的敏感指標,有統(tǒng)計學(xué)差異。10.經(jīng)統(tǒng)計分析發(fā)現(xiàn),胱抑素-C(P=0.001、OR=3. 4、95%C.I.=1.687-6. 855)是發(fā)現(xiàn)老年CKD的早期敏感指標,有統(tǒng)計學(xué)差異(P=0.001)。11.當肌酐臨界值為為123.80umol/L,其特異度0.917,敏感度0.738;當胱抑素-C的臨界值為1.88 mg/L時,其特異度0.875,敏感度0.776,此時可能為診斷早期腎功能損害的最佳臨界點。對肌酐和胱抑素-C判定結(jié)果做ROC曲線,肌酐曲線下面積為0.864,胱抑素-C曲線下面積為0.886,發(fā)現(xiàn)兩者對老年CKD有高度診斷價值,且胱抑素-C較肌酐有更高的診斷價值。12.本研究發(fā)現(xiàn),老年CKD死亡9人,占3. 15%,老年非CKD死亡0人;老年CKD死亡病因中,高血壓5人,占55. 55%,糖尿病2人,占22. 22%,痛風(fēng)1人,占11.11%,多囊腎1人,占11.11%;老年CKD死亡原因中,多器官功能衰竭6人,占66. 67%,濃毒血癥2人,占22. 22%,肺部感染1人,占11.11%。[結(jié)論]1.高血壓、糖尿病、慢性腎炎為老年CKD的常見病因,其次為糖尿病、慢性腎炎、痛風(fēng)、慢性間質(zhì)性腎炎、結(jié)締組織病、多囊腎。2.經(jīng)統(tǒng)計分析發(fā)現(xiàn),尿素、肌酐、尿酸、胱抑素-C、磷、紅細胞、血紅蛋白、尿蛋白、尿潛血是老年CKD的敏感指標。3.對肌酐和胱抑素-C判定結(jié)果做ROC曲線,發(fā)現(xiàn)兩者對老年CKD有高度診斷價值,且胱抑素-C優(yōu)于肌酐。
[Abstract]:[Objective]1. to analyze the clinical characteristics of Chronic Kidney Disease (CKD) for elderly patients with chronic renal disease (CKD), for the diagnosis of CKD in the elderly and to provide help for.2. to clear the cause of CKD in the high-risk group (elderly hospitalized patients), to provide a powerful basis for the early detection of old CKD in the clinic by.3. through the analysis of the clinical characteristics and etiological factors of the elderly CKD, and to guide the early stage of the CKD. Prevention and control, improve the quality of life of patients and prolong the survival time of patients. [Methods] Retrospective analysis of the basic data of hospitalized patients aged from January 1, 2016 to December 31, 2016 in the Department of Nephrology of the First Affiliated Hospital of Kunming Medical University. The exclusion conditions are as follows: (1) the age of 65 years; (2) the medical history is less than 3 months; (3) patients with incomplete data. Fruit]1. was a total of 2198 people, more than 65 years old and 310 people, aged CKD286, 92.26%, aged non CKD24, 7.74%, 192 men, 61.94%, 118 women, 38.06%, and 72.49 + 5.543 years of age. 81 years old and 28 people, accounting for 9.03%, G1, G2, G3a, G3b, G4, G5 were 135, 28, 21, 49, 44 and 9, respectively, in the aged CKD period, respectively, 47.20%, 9.79%, 7.34%, 17.13%, and 3.15%.2. 22 of gout, 7.96%, chronic interstitial nephritis in 8, 4 of connective tissue diseases, 1.40%, 3 of polycystic kidney, 1.05% and 10 in the other 10 people, and the main cause of CKD in 3. 50%. old age was hypertension.3., the main cause was hypertension, less than 69 years of age, 70-75 years, 76-80 years, or more than 81, respectively. 61.54%, 61.54%, 72%; the main causes of CKD in the elderly were hypertension, G1, G2, G3a, G3b, G4, and G5 accounted for 60.74%, 60.71%, 57.14%, 65.31%, 65.91%, 66.67%, 65 in the dialysis patients, 14.68%, and 221 in non dialysis patients, and the elderly CKD group and the elderly non CKD group were found to have no unification. X2=11.849, P=0.001, urinary protein (x2=19.903, P0.001), urinary occult blood (x2=6. 673, P=0. 010) were statistically different. The elderly CKD male (96.35%) was higher than the female (85.59%).5. by t test and found that the elderly CKD group and the elderly non CKD group total cholesterol (t=-1.457, 808), albumin (808), albumin (783)) Statistical difference was found in the elderly CKD group and the elderly non CKD group (t=-6.556, P0.001), red blood cell (t=-4.970, P0.001), uric acid (t=3.323, P=0.001), phosphorus (t=3.805, P=0.001), and the old group of the old group was lower than the old non CKD group. There was no significant difference in triglyceride between the elderly CKD group and the elderly non CKD group (Z=1. 083, P=0.191), and there was a statistical difference between the elderly CKD group and the elderly non CKD group (Z=2. 737, P0.001), creatinine (Z=3.079, P0.001), and cystatin -C (Z=3.064, and cystatin). There were no statistical differences in uric acid (F=1.709, P=0.133), calcium (F=1.684, P=0.138), and albumin (F=2.027, P=0.075) at all stages of CKD group. There were significant differences in hemoglobin (F=42.715, P0.001), red blood cells (F=37.893, P0.001) and phosphorus (001) in the aged CKD group. By the rank sum test analysis of phosphorus from G1 to G4, it was found that there was no statistical difference in the triglyceride (H=5.184, P=0.398) of the aged CKD group (H=5.184, P=0.398) at all stages, and the urea (H=187. 741, P0.001), creatinine (H=248. 711, P0.001) in the old CKD group and the cystatin C (.8.) were statistically different, and the urea, creatinine and cystatin were found from the 22 comparative analysis. From 1 to G5,.9. was gradually increased by statistical analysis, and urea (P=0.00, OR=1. 355, 95C. I.%=1.157-1.585), creatinine (P=0.02, OR=1.011,95C. I.=%1.004-1.108), uric acid (P=0.001, OR=1.007,95C. I., 032), phosphorus (820, 032), red blood cells (032), red blood cells ( P=0.002, OR=0.463,95C. I.%=0. 285-0. 750), hemoglobin (P=0. 001, OR=0. 972, 95C. I.%=0. 957-0. 988), urinary protein A3 level, urinary occult blood (309, 578) =3. 4,95%C.I.=1.687-6. 855) is an early sensitive index for the discovery of old CKD. There is a statistical difference (P=0.001).11. when the critical value of creatinine is 123.80umol/L, its specificity is 0.917, and the sensitivity is 0.738. When the critical value of cystatin -C is 1.88 mg/L, its specificity is 0.875, and the sensitivity is 0.776, which may be the best clinical diagnosis of early renal impairment. A ROC curve for the determination of creatinine and cystatin -C, the area under the creatinine curve was 0.864, the area under the cystatin -C curve was 0.886. It was found that both of them had a high diagnostic value for the elderly CKD, and cystatin -C had a higher diagnostic value than creatinine. This study found that 9 people died of CKD, 3.15% of the elderly, 0 elderly non CKD deaths, and CKD death in the elderly. Among the causes of death, 5 were hypertension, 55.55% were hypertension, 2 were diabetes, 1 were gout, 11.11% were gout, 1 were polycystic kidney, accounting for 11.11%. Among the causes of CKD death, there were 6 of multiple organ failure, 66.67%, 2, 22.22% and pulmonary infection, accounting for 66.67%, pulmonary infection 1, and 11.11%.. The statistical analysis of diabetes, chronic nephritis, gout, chronic interstitial nephritis, connective tissue disease, and polycystic kidney.2. showed that urea, creatinine, uric acid, Cystatin -C, phosphorus, red blood cells, hemoglobin, urine protein, and urine occult blood are the sensitive index of CKD in old age.3., and the ROC curves of creatinine and cystatin -C determination results are found, and they have been found to be high for the elderly CKD. The diagnostic value of cystatin -C was better than creatinine.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692

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