發(fā)布時(shí)間：2018-04-19 02:13

  本文選題：心血管疾病 + 透析方式　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討合并心血管疾病的終末期腎病透析患者的死亡率及死亡危險(xiǎn)因素。同時(shí)探討該研究人群中不同透析方式之間的死亡風(fēng)險(xiǎn)差異,探討合并心血管疾病的透析患者選擇何種透析方式具有更高的生存率。方法:前瞻性隊(duì)列研究。本研究共納入2009年5月一2014年5月來自廣州軍區(qū)總醫(yī)院及廣州市第一人民醫(yī)院的共591例透析患者。根據(jù)入組時(shí)有無合并心血管疾病分為合并心血管疾病組及無合并心血管疾病組。同時(shí)根據(jù)透析方式的不同分為血液透析組和腹膜透析組。通過采集基線人口統(tǒng)計(jì)學(xué)資料(包括年齡、性別、體質(zhì)指數(shù)、透析時(shí)程),合并癥(包括糖尿病、高血壓、腦卒中),實(shí)驗(yàn)室指標(biāo)包括(血紅蛋白、血清白蛋白、糖化血紅蛋白、高敏C反應(yīng)蛋白、血清鈣磷濃度、校正鈣、鈣磷乘積、Kt/V、尿酸、甘油三酯、膽固醇、高密度脂蛋白、低密度脂蛋白)。采用Cox比例風(fēng)險(xiǎn)模型進(jìn)行單因素及多因素分析合并心血管疾病的終末期腎病透析患者的死亡風(fēng)險(xiǎn)差異及死亡危險(xiǎn)因素。同時(shí)也探討不同透析方式之間的死亡風(fēng)險(xiǎn)差異。結(jié)果:本研究共納入終末期腎病透析患者共591例。其中合并心血管疾病的患者有123例,無心血管疾病的患者有468例。同時(shí)根據(jù)透析方式的不同,分為血液透析組和腹膜透析組。其中血液透析組有285例,腹膜透析組有306例。研究表明,在總?cè)巳褐?合并心血管疾病的透析患者死亡率要高于無合并心血管疾病的透析患者(HR=2.893,95%CI:1.804-4.693,P＜0.001)。其中在血液透析組中,合并心血管疾病的患者較無合并心血管疾病的患者有著更高的死亡率(HR=4.072,95%CI:2.036-8.142,P0.001)。在腹膜透析組中,合并心血管疾病的患者也較無合并心血管疾病的患者有著更高的死亡率(HR=3.083,95%CI:1.845-7.843,P0.001)。根據(jù)不同透析方式的研究結(jié)果表明,在合并心血管疾病患者中,血液透析組較腹膜透析組有著更高的死亡率(HR=1.569,95%CI:1.032-2.392,P0.001)。同樣地,在無合并心血管疾病患者中,也有相同的結(jié)論(HR=1.218,95%CI:1.109-1.348,P0.001)。在心血管疾病組中,以年齡、腦卒中、校正鈣、鈣、HbAlc等有意義的單因素指標(biāo)進(jìn)行多因素分析,結(jié)果顯示腦卒中(HR=3.802,95%CI:1.752-8.252,P=0.001)為心血管疾病組的獨(dú)立死亡危險(xiǎn)因素。在無合并心血管疾病組中,以年齡、糖尿病、腦卒中、血紅蛋白、Hs-CRP、HbAlc、膽固醇、HDL-C等有意義的單因素指標(biāo)進(jìn)行多因素分析,結(jié)果顯示糖尿病(HR=2.974,95%CI:1.560-5.668,P=0.001)及 hs-CRP(HR=1.107,95%CI:1.005-1.030,P=0.005)升高為無心血管疾病組的獨(dú)立死亡危險(xiǎn)因素。而在不同透析方式的研究中,多因素研究表明心血管疾病(HR=3.270,95%CI:1.573-6.798,P=0.002)、腦卒中(HR=2.479,95%CI:1.034-5.945,P=0.042)、Kt/V(HR=2.433,95%CI:1.610-3.676,P0.001)是血液透析組的死亡危險(xiǎn)因素。年齡(HR=1.063,95%CI:1.032-1.096,P0.001)、腦卒中(HR=3.980,95%CI:1.781-8.891,P=0.001)及低血紅蛋白(HR=0.966,95%CI:0.945-0.987,P=0.002)是腹膜透析組的死亡危險(xiǎn)因素。本研究表明,無論選擇何種透析方式,合并心血管疾病的透析患者的死亡率均高于無合并心血管疾病的透析患者。而無論有無合并心血管疾病,腹膜透析組的生存率均高于血液透析組。差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論:合并心血管疾病的透析患者死亡率高于無合并心血管疾病的透析患者,且腦卒中是合并心血管疾病的透析患者的死亡獨(dú)立危險(xiǎn)因素。合并心血管疾病的透析患者選擇腹膜透析較血液透析具有更高的生存率。
[Abstract]:Objective: To investigate cardiovascular disease in patients with ESRD dialysis mortality and death risk factors. At the same time to investigate the death risk differences between different dialysis methods in the study population, to investigate cardiovascular disease in dialysis patients the choice of dialysis has a higher survival rate. Methods: a prospective cohort study. The study included a total of 591 cases of dialysis patients in May 2009 May 2014 from General Hospita of Guangzhou Military Region and Guangzhou No.1 People's Hospital. According to the group without cardiovascular disease is divided into groups of patients with cardiovascular disease and combined cardiovascular disease group. At the same time according to different dialysis modalities for the group of hemodialysis and peritoneal dialysis. By collecting baseline demographic data (including age, gender, body mass index, dialysis duration), complications (including diabetes, hypertension, stroke), laboratory index package (including hemoglobin, serum albumin, hemoglobin, high sensitive C reactive protein, serum calcium and phosphorus concentrations, correction of calcium, calcium phosphorus product, Kt/V, uric acid, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein). Cox proportional hazards model was used for single factor and multiple factors analysis with cardiovascular disease end patients with ESRD dialysis the difference of the risk of death and death risk factors. It also explores the death risk differences between different dialysis methods. Results: the study included patients with ESRD dialysis. A total of 591 cases with cardiovascular diseases in 123 patients without cardiovascular disease in patients with 468 cases. At the same time, the way of dialysis the different, divided into the group of hemodialysis and peritoneal dialysis. The hemodialysis group had 285 cases, peritoneal dialysis group had 306 cases. The results show that in the general population, death and cardiovascular disease in hemodialysis patients The rate is higher than that of non dialysis patients with cardiovascular disease (HR=2.893,95%CI:1.804-4.693, P < 0.001). In the hemodialysis group, with cardiovascular disease patients than in patients without cardiovascular disease patients have a higher mortality rate (HR=4.072,95%CI:2.036-8.142, P0.001). In the peritoneal dialysis group, patients with cardiovascular disease are more complicated cardiovascular disease patients have a higher mortality rate (HR=3.083,95%CI:1.845-7.843, P0.001). According to a study of different dialysis methods results in patients with cardiovascular disease in hemodialysis group than in peritoneal dialysis patients had a higher mortality rate (HR=1.569,95%CI:1.032-2.392, P0.001). Similarly, in the absence of cardiovascular disease in patients with the same conclusion (HR=1.218,95%CI:1.109-1.348, P0.001). In the cardiovascular disease group, with age, stroke, correction of calcium, calcium, and other significant HbAlc The single factor analysis of multiple factors showed that stroke (HR=3.802,95%CI:1.752-8.252, P=0.001) for cardiovascular disease were independent risk factors of death. In patients with cardiovascular disease group, with age, diabetes, stroke, hemoglobin, Hs-CRP, HbAlc, cholesterol, single index significant HDL-C multi factor analysis the results showed that diabetes, (HR=2.974,95%CI:1.560-5.668, P=0.001) and hs-CRP (HR=1.107,95%CI:1.005-1.030, P=0.005) increased independent risk factors of death for cardiovascular disease group. In different dialysis methods study, multivariate studies show that cardiovascular disease (HR=3.270,95%CI:1.573-6.798, P=0.002), stroke (HR=2.479,95%CI:1.034-5.945, P=0.042), Kt/V (HR=2.433,95%CI:1.610-3.676, P0.001) is the risk factors of death in hemodialysis group. Age (HR=1.063,95%CI:1.032-1.096, P0.001), stroke In (HR=3.980,95%CI:1.781-8.891, P=0.001) and low hemoglobin (HR=0.966,95%CI:0.945-0.987, P=0.002) were risk factors of death in peritoneal dialysis group. This study shows that, regardless of the choice of dialysis, and cardiovascular disease mortality in dialysis patients were higher than that of the patients without cardiovascular disease in dialysis patients. With or without cardiovascular disease, the survival rate of peritoneal dialysis. Were higher than the hemodialysis group. The difference was statistically significant. Conclusion: the mortality of patients with cardiovascular disease in dialysis than those without cardiovascular disease in dialysis patients, and stroke are the independent risk factors of death in dialysis patients with cardiovascular disease. Cardiovascular disease in dialysis patients with peritoneal dialysis hemodialysis has a higher survival rate.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5;R54

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