糖尿病肾脏病透析患者社会经济地位与死亡率相关性的回顾性队列研究

A retrospective cohort study on relationship between socioeconomic status and mortality in patients with diabetic kidney disease on hemodialysis

目的通过采用回顾f生队列研究的方法，探讨糖尿病肾脏病（DKD）透析患者社会经济地位（SES）与死亡率的相关性。方法回顾性查阅2006年1月至2010年3月在天津市第四中心医院进行透析的DKD患者病例资料，调查受试对象的SES（受教育程度、家庭成员平均月收入、职业类型），按SES高低将其分为2组，比较2组第1年、第3年、第5年的死亡率，计算相对危险度（RR）、归因危险度（AR）、归因危险度百分比（ARP），并分析SES与各变量的相关性。结果2组间年龄、性别、糖尿病病程、肾病病程等基线一致，具有可比性。低SES组第1年死亡的RR=I．08，AR=I．5％，ARP=8．1％；第3年死亡的RR=I．38，AR=10．9％，ARP=27。6％；第5年死亡的RR=1.57，AR=24．5％，ARP=-36．4％。相关分析显示SES总分与身体质量指数（BMI）、糖化血红蛋白（HbAlc）、C-反应蛋白（CRP）呈负相关（r分别为-0．542、-0．314、-0．392，均P〈0．01），与血清白蛋白（ALB）、生理机能、一般健康状况、社会功能、情感职能、精神健康得分呈正相关（r分别为0．539、0．243、0．254、0．268、0．253、O．255，均P〈0．01）。结论SES可能是DKD患者死亡的的重要社会学病因，分析其可能通过影响患者生活质量、血糖控制水平、营养及炎症状态而影响DKD透析患者的长期生存率。

Objective To explore the correlation between socioeconomic status （SES） and mortality of patients with diabetic kidney disease （DKD） on hemodialysis by using a retrospective cohort study. Methods Cases with DKD on hemodialysis in the Fourth Central Hospital of Tianjin from Jan. 2006 to Mar. 2010 were retrospectively reviewed. SES, including education, the average monthly income of household members, occupation type, was surveyed among all the patients. According to the SES, the patients were divided into two groups. The 1-year, 3-year, and 5-year mortality rates of the two groups were compared respectively. Relative risk （RR）, attributable risk （AR） and attributable risk percentage （ARP） were calculated. Further, the relevance of SES and other variables were analyzed. Results The baseline of two groups in age, sex, duration of diabetes, kidney disease progression was consistent and comparable. In the low SES group, 1-year death RR was 1.08, AR was 1.5% and ARP was 8.1%. Three-year death RR was 1.38, AR was 10.9% and ARP was 27.6%. Five-year death RR was 1.57, AR was 24.5% and ARP was 36.4%. Correlation analysis showed that SES scores were negatively correlated to body mass index （BMI）, glycated hemoglobin （HbAlc） and C-reactive protein （CRP） （r=-0.542, -0.314, -0.392, P〈0.01）, while SES scores were positively correlated to serum albumin （ALB）, physiological function, general health, social function, emotional function and mental heahh scores （r=0.539, 0.243, 0.254, 0.268, 0.253, 0.255, P〈0.01）. Conclusions SES is an important social-influencing factor of mortality in patients with DKD ,and may have effects on long-term survival of hemodialysis patients by influencing the quality of life, glycemic control, nutrition and inflammation.