近5年维持性血液透析患者的流行病学调查分析

Epidemiological analysis of the maintenance hemodialysis patients over the past 5 years

目的对单中心维持性血液透析（maintain hemodialysis,MHD）患者的现状及流行病学情况进行调查分析,为规范临床治疗及持续质量改进提供数据支持。方法回顾分析2010年1月~2014年12月在山西医科大学第二医院肾内科血液净化中心透析超过3个月的MHD患者的病例资料,包括患者性别、年龄、医疗费用类型、肾脏病病因、首次透析使用的血管通路、并发症、转归、死亡原因及生存率等。各种相关数据的采集通过全国血液净化病例登记系统完成。结果 ①近5年新进入我院血液净化中心的患者人数逐年递增。2010年1月~2014年12月在我院进行MHD治疗的终末期肾脏病（end stage renal disease,ESRD）患者共计513例,其中男性291例,女性222例,男女比例1.3：1。②ESRD患者开始血液透析的年龄最主要集中在40~49岁和50~59岁。③发病原因明确431例,居前3位分别是慢性肾小球肾炎207例占48.0%,糖尿病肾病112例占25.9%,高血压肾损害46例占10.7%。④首次透析时使用的血管通路中,临时中心静脉置管居于第1位,占到76.8%,其次是自体动静脉内瘘占21.5%。⑤血液透析患者的并发症最常见为贫血,其次为高血压、骨矿物质代谢紊乱等。血红蛋白、血压、血钙、血磷和全段甲状旁腺激素（i PTH）的达标率均不足50%。⑥513例MHD患者,12人行肾移植,11人转为腹膜透析,385人转其他医院治疗,5人脱离透析,9人放弃治疗,67人在我院继续血液透析治疗,死亡24人。心脑血管事件是血液透析患者死亡的主要原因。⑦MHD患者的1年生存率为93.3%,5年生存率75.3%,10年生存率14.6%,生存期最长1例超过228月仍在规律血液透析治疗。结论本组MHD患者以中老年人群为主,男性略多于女性。血液透析患者前3位原发病因依次为慢性肾小球肾炎、糖尿病肾病、高血压肾损害。首次透析时的血管通路以临时中心静脉置管占的比例最高,其次为自体动静脉内瘘,适时透析的问题需得到关注并改进。贫血、高血压、骨矿物质代谢紊乱的发生率仍高且达标率低。心脑血管事件是血液透析患者死亡的主要原因。随着血液透析治疗时间延长,患者的长期生存率逐渐下降。

Objective To obtain the data supporting standardized treatment and continuously improving the quality of hemodialysis, we investigated the current treatment status and epidemiology of maintenance he- modialysis （MHD） patients in our hemodialysis center. Methods We retrospectively reviewed the clinical re- cords of 513 MHD patients treated for more than 3 months in the Blood Purification Center, the Second Hospi- tal of Shanxi Medical University between Jan. 2010 and Dec. 2014. Gender, onset age, medical expense type, primary renal disease, the first vascular access type, complications, changes of treatment, cause of death, and survival rate were analyzed. All related data were collected through the Chinese National Renal Data System. Results ①In our hemodialysis center, the number of hemodialysis patients increased annually. Among the 513 MHD patients, 291 were males and 222 were females with a male/female ratio of 1.3 to 1. ②Most pa- tients with end stage renal disease （ESRD） were in the age of 40 to 49 years and 50 to 59 years. ④In the 431 patients with defined causes of ESRD, the top 3 primary causes were glomerulonephritis （48.0%）, diabetic ne- phropathy （25.9%）, and hypertensive nephrosclerosis （10.7%）.④The first used vascular access at the begin- ning of hemodialysis was temporary central venous catheter （76.8%）, and primary arteriovenous fistula （21.5%）.⑤Anemia was the most common complication, followed by hypertension, bone and mineral disor- ders. The rates achieved to the recommended levels of hemoglobin, blood pressure, blood calcium, blood phosphorus and IPTH were less than 50%. ⑥Among 513 MHD patients, 12 received renal transplantation, 11 changed to peritoneal dialysis, 385 transferred to other hospitals for hemodialysis, 5 got rid of dialysis, 9 gave up the treatment, 24 died, and 67 were still hospitalized in our unit. Cardiovascular and cerebrovascular inci- dences were the leading causes of death. ⑦The survival rate of MHD patients was different： 93.3% in one year, 75.3% in five years, 14.6% in ten years, and one for more than 228 months and still under regular dialy- sis. Conclusion In our dialysis center, the majority of the MHD patients were middle aged and elderly males. The first three primary causes leading to ESRD were glomerulonephritis, diabetic nephropathy, and hy- pertensive nephrosclerosis. The major vascular access at the beginning of hemodialysis was temporary central venous catheter, suggesting that timely hemodialysis should be emphasized. The incidence rate of anemia, hy- pertension, bone and mineral disorders were high, but the control rates were low. Cardiovascular and cerebro- vascular incidences were the leading cause of death. As the hemodialysis treatment was prolonged, the long- term survival rate of MHD patients was gradually reduced.