广东省中山市小榄地区维持性血液透析患者现状调查

Investigation on Maintenance Hemodialysis Patients in Xiaolan Town of Zhongshan City of Guangdong Province

目的调查了解中山市小榄地区近3年血液透析患者的现状及问题。方法统计2011年1月至2014年1月中山市小榄地区开展血液透析治疗的单位登记于"全国血液净化病例信息系统"的所有维持性血液透析患者资料。分析患病率、原发病因、透析充分性与透析频率、肝炎病毒感染情况、死亡原因等,且比较自费与医保患者的治疗效果。结果 2011年1月份本地区终末期肾脏病维持性血液透析患者281人,占该地区总人口比例0.11‰;2014年1月共有维持性血液透析患者427人,占该地区总人口比例为0.14‰,患病率比较差异无统计学意义(P〉0.05)。患者首位原发病因由2011年的慢性肾小球肾炎(占34.16%),转变为糖尿病肾病(占31.15%)。3年间血液透析充分性与透析频率均不断提高,2014年与2011年比较差异有统计学意义(P<0.05,P<0.01)。2011年乙型肝炎、丙型肝炎病毒感染率分别为10.68%、4.63%;2014年乙型肝炎、丙型肝炎病毒感染率分别为9.13%与6.32%。3年间血液透析患者平均年死亡率为8.25%,首位死亡原因是心血管事件,占24.71%。享受基本医保的患者在透析依存性、治疗效果上均明显优于自费患者,差异有统计学意义(P<0.05,P<0.01)。结论本地区近3年维持性血液透析患者人数不断增加,透析质量与患者的生存质量也不断提高,但心脑血管并发症仍是影响血液透析患者生存率与生活质量的主要因素。

Objective To investigate the situation and problems of maintenance hemodialysis patients in Xiaolan Town in Zhongshan City during the last three years.Methods All the data of maintenance hemodialysis patients was collected,which was registered in the ＂Chinese National Renal Data System＂ from January 2011 to January 2014 in Xiaolan totwn.The analysis included the prevalence rate,primary cause,adequacy and frequency of dialysis,infection rate of hepatitis virus,and death cause.Besides,the treatment effects were compared among the patients with and without insurance.Results There were 281 maintenance hemodialysis patients in Xiaolan Town on January 2011,and the proportion of the total population was 0.11‰.The number of patients increased to 427 on January 2014 and the proportion was 0.14‰.The difference of the proportion was not statistically significant （P ＞ 0.05）.In 2011,the fist primary cause of end stage renal disease in maintenance hemodialysis patients was chronic glomerulonephritis （34％）,but it came to be diabetes in 2014 （31％）.The dialysis adequacy and frequency were improved during the last three years,and the difference of these indexes of patients in 2011 and 2014 was statistically significant （P ＜ 0.05 or ＜ 0.01）.The hepatitis B and hepatitis C virus infection rates were 10.7％ and 4.6％ respectively in 2011,and the rates were 9.1％ and 6.4％ respectively in 2014.The average annual death rate was 8.2 ％,and the first cause of death was cardiovascular events,which accounted for 24.7 ％ of total deaths.Meanwhile,the patients with basic health insurance of Zhongshan City had better dependency and treatment effect comparing with self-paying patients,and significant difference can be found between these two groups （P ＜ 0.05 or ＜ 0.01）.Conclusions The population of maintenance hemodialysis patients was increasing during the last three years in Xiaolan town in Zhongshan City while the quality of dialysis and quality of life were improved.However,Cardiovascular and cerebrovascular complications remains the main threat to the blood dialysis patients＇ survival rate and life quality.