腹膜透析生存率及其预后分析

Survival Probability and Multivariate Analysis of Prognostic Factors in Continuous Ambulatory Peritoneal Dialysis Patients

目的 :调查腹膜透析病人的生存率及其独立的预后因素 ,识别病人死亡的高危人群 ,以指导临床治疗。方法 :随诊腹膜透析病人 2 6 8例 ,采用Kaplan -Meirie法分析生存率 ,采用COX模型多变量分析透析前各临床指标对预后的影响。结果 :2 6 8例病人中位数随访时间为 2 6个月 ;1年、2年、3年及 4年总体生存率分别为 85 .6 %、6 7.1%、5 6 .9%及 44 .4% ;经时序检验 ,透析前病人年龄、体重、经济状况、残余尿量、原发病、合并疾病、血红蛋白、血清白蛋白、血清尿素氮、肌酐及血磷浓度对生存率均有影响 (P值均 <0 .0 5 ) ;经COX回归分析 ,透析前病人年龄、血清白蛋白及合并疾病成为独立的预后因素。结论 :我国腹膜透析远期生存率稍低于西方发达国家。根据透析前年龄、血清白蛋白及有无合并疾病 。

Objective: To identify risk factors influencing survival in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: 268 cases of CAPD patients were followed. Survival probability was studied with Kaplan-Meier method and clinical prognostic factors were analyzed with the Cox Proportional Hazards model. Results: The median follow-up duration was 26 months. The overall survival probability at 1, 2, 3 and 4 year was 85.6%, 67.1%, 56.9% and 44.4% respectively. Patients with age>55, weight<50 kg, poor economic status, residual urine volumes<500 ml/d, having comorbidities, hemoglobin<60 g/L, serum albumin<33 g/L, blood urea<35.7 mmol/L, serum creatinine<800 μmol/L, and serum phosphate<2.5 mmol/L had lower survival probabilities. Cox regression showed age, serum albumin and comorbidities were independent prognostic predictors. Conclusion: Long-term survival probabilities of CAPD patients in China are slightly lower than those in western developed countries. The prognosis of patients can be preliminarily analyzed based on their ages, serum albumin and comorbidities before initiation of dialysis.