本文選題：終末期腎臟病 + 血液透析　； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景:維持性血液透析(maintenance hemodialysis, MHD)是治療終末期腎臟病的重要方法之一,盡管血液透析水平在不斷提高,MHD患者的死亡風(fēng)險(xiǎn)與普通人群相比仍然較高。因此,了解MHD患者死亡風(fēng)險(xiǎn)因素十分重要。MHD患者的生存期從數(shù)月到數(shù)十年不等,不同生存期的MHD患者死亡風(fēng)險(xiǎn)因素是否相同尚未得到深入研究。此外,有研究發(fā)現(xiàn),MHD患者在死亡之前有一定的臨床特點(diǎn),而我國(guó)關(guān)于MHD患者死亡之前臨床特點(diǎn)及其與死亡的相關(guān)性研究較少。因此,本研究旨在分析MHD患者不同生存期死亡風(fēng)險(xiǎn)因素的異同,及MHD患者死亡之前的臨床特點(diǎn)及其與死亡的相關(guān)性。方法:本研究共兩部分,第一部分將解放軍總醫(yī)院2004-2014年新進(jìn)入血液透析并且符合入選標(biāo)準(zhǔn)的患者作為研究對(duì)象,收集其基線數(shù)據(jù),并隨訪至2015年12月31日,使用COX回歸分析分別探討MHD患者3-12個(gè)月、13-36個(gè)月、37-60個(gè)月、61-144個(gè)月各生存期死亡風(fēng)險(xiǎn)因素,從而了解MHD患者不同生存期死亡風(fēng)險(xiǎn)因素的異同;第二部分將我國(guó)16家血液凈化中心2012-2014年的MHD患者作為研究對(duì)象,將死亡患者死亡前與存活患者研究結(jié)束之前的臨床特征進(jìn)行比較,并通過(guò)Logistic回歸分析死亡相關(guān)因素,從而了解MHD患者死亡之前臨床特點(diǎn)及死亡相關(guān)影響因素。結(jié)果:第一部分研究共納入392名患者,多因素COX回歸分析顯示,MHD患者3-12個(gè)月的死亡風(fēng)險(xiǎn)因素為低水平血清白蛋白(HR=0.849, 95%CI:0.750-0.962); 13-36 個(gè)月的死亡風(fēng)險(xiǎn)因素為增齡(HR=1.057, 95%CI: 1.021-1.095)及糖尿病腎病(HR=2.959, 95%CI: 1.239-7.070),血清白蛋白水平較高(HR=0.909,95%CI: 0.831-0.993)及甘油三酯≥1.7 mmol/L (HR=0.209, 95%CI: 0.080-0.543)的患者死亡風(fēng)險(xiǎn)較低;患者37-60個(gè)月及61-144個(gè)月的死亡風(fēng)險(xiǎn)均為增齡(37-60個(gè)月 HR=1.064, 95%CI: 1.021-1.110, 61-144 個(gè)月 HR=1.096, 95%CI: 1.041-1.153)。第二部分共納入4104名患者,與存活組患者相比,死亡組患者中男性、糖尿病腎病及高血壓腎損害患者所占比例較高,同時(shí),死亡組患者具有較低的透析前舒張壓、血紅蛋白、血清白蛋白、血鈣、血磷、spKt/V水平及較高的年齡。Logistic回歸分析顯示,男性(OR=1.437, 95% CI: 1.094-1.886)、增齡(OR=1.046, 95% CI:1.036-1.057)、原發(fā)疾病為糖尿病腎病(OR=1.837, 95% CI: 1.322-2.552)、低水平血鈣(OR=0.585, 95% CI: 0.346-0.989)、低水平血紅蛋白(OR=0.974, 95% CI:0.967-0.981)和低水平血清白蛋白(OR=0.939, 95% CI: 0.915-0.963)是死亡相關(guān)危險(xiǎn)因素。結(jié)論:不同生存期的MHD患者死亡風(fēng)險(xiǎn)因素并不相同,同時(shí)MHD患者死亡之前具有一定的臨床特征,了解患者在不同生存期的死亡風(fēng)險(xiǎn)因素有助于對(duì)患者的預(yù)后進(jìn)行判斷及有效干預(yù)。
[Abstract]:Background: maintenance hemodialysis (MHD) is one of the most important methods for the treatment of end-stage renal disease, although the risk of death of MHD patients is still higher than that of the general population. Therefore, it is very important to understand the death risk factors of MHD patients. The survival time of MHD patients varies from months to decades. Whether the death risk factors of MHD patients with different survival periods are the same has not been further studied. In addition, some studies have found that MHD patients have certain clinical characteristics before death, but there are few studies on the clinical characteristics and their correlation with death in MHD patients in China. Therefore, the purpose of this study was to analyze the differences and similarities of death risk factors in MHD patients with different survival periods, and to analyze the clinical features of MHD patients before death and their correlation with death. Methods: this study consists of two parts. In the first part, the patients newly entered hemodialysis in PLA General Hospital from 2004 to 2014 and who met the inclusion criteria were selected as the study subjects, and their baseline data were collected and followed up until December 31, 2015. COX regression analysis was used to study the risk factors of death in patients with MHD from 3-12 months to 13-36 months and from 37-60 months to 61-144 months, so as to understand the similarities and differences of death risk factors among different survival periods in patients with MHD. In the second part, the MHD patients from 16 blood purification centers in China from 2012 to 2014 were studied. The clinical characteristics of the dead patients before death and those of the surviving patients were compared, and the factors related to death were analyzed by Logistic regression analysis. In order to understand the clinical characteristics of MHD patients before death and death related factors. Results: the first part of the study involved 392 patients. Multivariate COX regression analysis showed that the risk factors for death in patients with MHD for 3-12 months were low serum albumin (HR0.849), 95 CI: 0.750-0.962U, 13-36 months mortality risk factors (HR1.057, 95CI: 1.021-1.095) and diabetic nephropathy (HR2.959, 95CI1.239-7.0707), the serum albumin level was higher than 0.90995 CI: 0.831-993) Patients with triglyceride 鈮，

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