本文選題：老年 + 血液透析　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:了解我國綜合性醫(yī)院老年終末期腎病患者行血液透析和腹膜透析治療的人群特征,評估他們的生存情況,比較兩者的生存差異,探討影響生存率的相關(guān)因素。方法:回顧性分析了本院2008年1月1日至2014年12月31日新進(jìn)入透析并維持透析治療≥3個月、年齡≥60歲老年患者,收集他們的人口統(tǒng)計(jì)學(xué)資料及臨床資料,隨訪至2015年9月30日,應(yīng)用傾向性評分法匹配出兩組患者,然后采用Kaplan□ Meier法、Log-rank檢驗(yàn)及Cox回歸模型分析患者的生存率及預(yù)后的影響因素,期間采用意向治療分析(intention to treat analysis)和接受治療分析(as treated analysis)兩種方法。結(jié)果:1.共納入患者447例,其中起始HD組236例,起始PD組211例,應(yīng)用傾向評分匹配法(propensity score method,PSM)匹配成功174對患者,兩組患者基線資料比較,包括開始透析時的年齡、性別、Charlson合并癥指數(shù)(CCI)、原發(fā)病、血清肌酐、血紅蛋白、血漿白蛋白、鐵蛋白、轉(zhuǎn)鐵蛋白飽和度、腎小球?yàn)V過率(eGFR)、射血分?jǐn)?shù)等差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者主要死因均為心、腦血管意外及感染,兩組死因比較無顯著差異(P0.05)。2.意向治療分析:Kaplan-Meier生存曲線顯示,HD組和PD組1年、5年的存活率分別為93.6%、63.4%和91.9%、61.5%,兩組總體生存率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。HD80歲組生存率明顯高于HD≥80歲組,差異有統(tǒng)計(jì)學(xué)意義(Log-rank檢驗(yàn),P=0.015);糖尿病腎病HD組生存率明顯低于非糖尿病腎病HD組,差異有統(tǒng)計(jì)學(xué)意義(Log-rank檢驗(yàn),P=0.032);開始透析時CCI5HD組生存率明顯高于CCI≥5HD組(Log-rank檢驗(yàn),P=0.016)。根據(jù)以上的3種分層結(jié)果發(fā)現(xiàn),PD組組內(nèi)及HD組和PD組組間比較,生存率差異均無統(tǒng)計(jì)學(xué)意義(Log-rank檢驗(yàn),P0.05)。Cox多因素回歸分析顯示,高齡(≥80歲)(P0.001,HR=1.058,95%CI 1.028～1.088)、原發(fā)病為糖尿病腎病(P=0.001,HR=2.161,95%CI 1.384～3.373)、開始透析時 CCI≥5(P=0.007,HR=1.935,95%CI 1.201～3.117)顯著影響HD患者的生存率;高齡(≥80歲)(P=0.022,HR=1.043,95%CI 1.006～1.081)、血漿白蛋白35 g/L(P=0.025,HR=1.776,95%CI 1.075～2.934)、前白蛋白30 g/L(P=0.012,HR=0.968,95%CI 0.944～0.993)顯著影響PD患者的生存率。3.接受治療分析結(jié)果與意向治療分析結(jié)果基本一致。結(jié)論:1.≥60歲的老年HD組與PD組總體生存率差異無統(tǒng)計(jì)學(xué)意義;2.HD80歲組生存率明顯高于HD≥80歲組;糖尿病腎病HD組生存率明顯低于非糖尿病腎病HD組;開始透析時CCI5 HD組生存率明顯高于CCI≥5 HD組。3.高齡、原發(fā)病為糖尿病腎病、開始透析時CCI≥5是老年HD患者生存率的獨(dú)立影響因素;高齡、血漿白蛋白35 g/L、前白蛋白30g/L是老年P(guān)D患者生存率的獨(dú)立影響因素。
[Abstract]:Objective: to investigate the population characteristics of elderly end-stage nephropathy patients undergoing hemodialysis and peritoneal dialysis in Chinese general hospitals, to evaluate their survival status, to compare their survival differences, and to explore the related factors affecting survival rate. Methods: from January 1, 2008 to December 31, 2014, the elderly patients aged more than 60 years, who entered dialysis and maintained dialysis treatment for more than 3 months, were analyzed retrospectively, and their demographic data and clinical data were collected. The patients were followed up until September 30, 2015. The two groups were matched by tendentiousness score, and then the survival rate and prognostic factors were analyzed by Kaplan-Meier method with Log-rank test and Cox regression model. Intention to treat analysis) and treatment analysis as treated analysis were used. The result is 1: 1. A total of 447 patients were included, including 236 patients in HD group and 211 patients in PD group. 174 pairs of patients were matched successfully by propensity score method. Baseline data of the two groups were compared, including age at the time of dialysis. Sex Charlson complication index (CCI), primary disease, serum creatinine, hemoglobin, plasma albumin, ferritin, transferrin saturation, glomerular filtration rate (GFR) and ejection fraction were not significantly different (P 0.05). The main causes of death in the two groups were heart, cerebrovascular accident and infection. There was no significant difference in the cause of death between the two groups (P0.055.2.) The 1 year survival rate of HD group and PD group were 93.63.4% and 91.9%, respectively. There was no significant difference in overall survival rate between the two groups. The survival rate of HD group was significantly higher than that of HD 鈮，

本文編號：1951805