单中心2272例新增维持性血液透析患者的病因构成及其变迁

Changes of protopathy distribution in 2 272 patients with maintenance hemodialysis

目的 分析海南省人民医院血液净化中心新增维持性血液透析（MHD）患者的病因构成变化.方法 对1992年4月至2012年12月新增MHD治疗的2 272例终末期肾脏病患者的病因进行分析,首先以进入透析的不同时间段分为四组,A组为1992年4月至1997年12月（n=315）;B组为1998年1月至2002年12月（n=396）;C组为2003年1月至2007年12月（n=637）;D组为2008年1月至2012年12月（n=924）.其次以不同性别间和以不同年龄段间进行分组分析.结果 （1） 20年中2 272例患者的前四位病因依次是慢性肾炎（CGN）、糖尿病肾病（DN）、梗阻性肾病和高血压肾病;（2）以进入透析的不同时间段分组分析中,CGN所占比率呈下降趋势,由A组的62.9%降至D组的37.2%;DN和高血压肾病所占比率逐渐上升,分别由3.8%升至22.7%和由3.8%升至11.3%,且D组患者中高血压肾病所占比率为11.3%,超过梗阻性肾病的9.1%,成为第三病因;（3）男性患者中梗阻性肾病和高血压肾病所占的比率分别为14.1%和9.8%,均高于女性患者的7.1%和6.3%,差异均有统计学意义（P〈0.05）;（4）年龄不同,DN所占的比率先升后降,60~70岁组所占比率最高,达30.4%;高血压肾病所占的比率逐渐增长,≥70岁组最高,达21.7%.结论 近20年海南地区新增MHD患者以CGN、DN、梗阻性肾病和高血压肾病为主要病因,但DN和高血压肾病所占比率逐渐增加.

Objective To study the changes of protopathy distribution in 2 272 patients with maintenance he-modialysis （MHD） in Blood Purification Center of People＆#39;s Hospital of Hainan Province. Methods The clinical data of patients with chronic kidney disease initiated MHD treatment during April 1992 to December 2012 were reviewed and analyzed. There were 2 272 MHD patients, which were divided into four groups according to the time of initiated MHD： group A （n=315, April 1992 to Dec. 1997）, group B （n=396, Jan. 1998 to Dec. 2002）, group C （n=637, Jan. 2003 to Dec. 2007）, and group D （n=924, Jan. 2008 to Dec. 2012）. The patients were also grouped according to gender （male and female） and age （〈30,30~40,40~50, 50~60, 60~70 and≥70 years old）. The protopathy distribution in dif-ferent groups were analyzed and compared. Results （1） Chronic glomerular nephritis （CGN）, diabetic nephropathy, obstructive nephropathy and hypertensive nephropathy were the most common causes for the 2 272 MHD patients in the 20 years. （2） In the analysis of different time periods, the ratio of CGN decreased significantly, from 62.9% in group A to 37.2%in group D. And the ratio of diabetic nephropathy increased significantly, from 3.8%in group A to 22.7%in group D. The ratio of hypertensive nephropathy increased from 3.8%in group A to 11.3%in group D. The ra-tio of hypertensive nephropathy was 11.3%in group D and the ratio of obstructive nephropathy was 9.1%. Therefore, hypertensive nephropathy was the third cause in group D. （3） The ratios of obstructive nephropathy and hypertensive nephropathy in male patients group were 14.1%and 9.8%, significantly higher than 7.1%and 6.3%in female patients group, respectively （P〈0.01）. （4） The distribution of diabetic nephropathy and hypertensive nephropathy was signifi-cantly different in various age groups. The biggest ratio of diabetic nephropathy was 30.4%in 60~70 years old group. The biggest ratio of hypertensive nephropathy was 21.7% in ≥70 years old group. Conclusion In the recent 20 years, CGN, DN, obstructive nephropathy and hypertensive nephropathy were the main causes for the 2 272 new MHD patients, with the proportion of DN and hypertension nephropathy increased gradually.