儿童慢性肾衰竭多因素Cox生存分析

The Cox's proportional hazard regression model for chronic renal failure in children

目的探讨慢性肾功能衰竭(chronic renal failure,CRF)患儿的临床特点及影响其预后的危险因素。方法回顾性分析2002年1月至2008年9月在北京儿童医院住院治疗的127例CRF患儿的临床表现,随访其中71例患儿的生存状态。应用Kaplan-Meier法和Cox比例风险模型对影响患儿预后的危险因素进行单因素和多因素分析。结果CRF患儿的原发病以先天性及遗传性肾脏疾病为主(48.9%);临床表现以血液系统、消化系统受累症状为多,1/3以上患儿有不同程度的高血压和体格发育落后;平均生存时间为85.3个月,中位生存时间67.0个月,5年和10年生存率分别为50%和21%;主要与预后相关的危险因素有治疗方法(对症P=0.000,RR=53.901,透析P=0.047,RR=4.361)、高磷血症(P=0.000,RR=10.298)、高钾血症(P=0.008,RR=5.053)、水钠潴留(P=0.003,RR=3.714)和大量蛋白尿(P=0.027,RR=2.438)。结论治疗方法、高磷血症、高钾血症、水钠潴留和大量蛋白尿是影响CRF患儿预后的主要危险因素,是否进行肾移植是对预后影响最大的因素。

Objective To evaluate the clinical characteristics and prognostic risk factors of the chronic renal failure （CRF） in hospitalized children.Methods The information on the clinical manifestations of 127 patients with CRF were collected from January 2002 to September 2008 retrospectively in Beijing Children＇s Hospital.Seventy-one patients were followed up.Kalplan-Meier methods and Cox＇s proportional hazard regression model were used to analyze prognostic risk factors.Results The primary renal diseases of CRF were congenital structural abnormalites and hereditary real disorders （48.9%）.Hematological system and digestive system were most common involved.More than 1 /3 children had high blood pressure and underdevelopment.The average survival time was 85.3 months and the median survival time was 67.0 months.The five and ten years survival rates were 50% and 21%.The risk factors associated with prognosis were treatment modality （symptomatic treatment,P=0.000,RR=53.901;dialysis,P=0.047,RR=4.361）,hyperphosphatemia （P=0.000,RR=10.298）,hyperkalemia （P=0.008,RR=5.053）,water-sodium retention （P=0.003,RR=3.714） and hyperproteinuria （P=0.027,RR=2.438）.The renal graft was the most important impact factor on prognosis.Conclusions The prognostic risk factors of CRF in children are treatment modality,hyperphosphatemia,hyperkalemia,water-sodium retention and hyperproteinuria.