维持性腹膜透析及血液透析患者丙肝感染调查研究及危险因素分析

Investigation of hepatitis C infections in maintenance peritoneal dialysis and hemodialysis patients and risk factor analysis

目的 探讨维持性腹膜透析（M PD）及血液透析（MHD）患者中丙肝病毒（HCV）感染情况及危险因素,为临床防治提供理论参考.方法 随机选择我院2011年10月至2014年10月年间行规律MHD的终末期肾病患者共182例作为观察组,选择同期行MPD的终末期肾病患者120例作为对照组,检测其HCV感染情况,同时搜集其一般资料、透析相关资料、急慢性合并症、透析充分性、炎症指标、蛋白质和能量摄入水平等进行单因素及多因素Logistic回归分析.结果 观察组182例患者中,发生HCV感染患者共22例,发生率为11.5％,对照组120例患者中,发生HCV感染患者共4例,发生率为3.3％,HCV感染在MHD中的比例明显高于MPD患者（P＜0.05,x2=7.04）;单因素分析提示,C-反应蛋白（CRP）高、合并急慢性并发症多、透析时间长、透析频率高、血清白蛋白（Alb）低、蛋白质摄入量（DPI）低、总残肾尿素清除指数（Kt/V）低是其危险因素;经多因素logitic回归分析,最终透析时间长、急慢性合并症多、Alb低、DPI低和CRP是MHD患者HCV感染危险因素.结论 积极改善其微炎症状态,加强营养支持来积极降低HCV感染率.

Objective To investigate hepatitis C virus （HCV） infections and the risk factors in the maintenance peritoneal dialysis （MPD） and hemodialysis （MHD） patients, so as to provide a theoretical reference for the clinical prevention and treatment.Methods From Oct.2011 to Oct.2014, 182 end stage renal disease （ESRD） patients receiving MHD were selected as the observation group and 120 cases of ESRD patients receiving MPD were selected as the control group in our hospital.The HCV infections were detected.The general information, dialysis related data, acute and chronic complications, dialysis adequacy, inflammatory markers, protein and energy intake levels were collected for single factor and multi factors logistic regression analysis.Results HCV infection rate was 11.5% in the observation group and 3.3% in the control group.There was significantly difference between both groups （P 〈 0.05, x2 =7.04）.The results of single factor analysis showed that higher CRP, more acute and chronic complications, longer duration of dialysis, more dialysis frequency, low ALB, low DPI, low total Kt/V were the risk factors.Multivariate logistic regression analysis presented that the longer final dialysis time, the more acute and chronic complications.Low Alb, low DPI and high CRP were the risk factors of HCV infection in MHD patients.Conclusions Improvement of the micro inflammatory status, and strengthened nutrition support can actively reduce the infection rate of HCV.