维持性血液透析患者死亡原因及相关影响因素分析

Analysis on death causes and related influence factors of the patients with maintenance hemodialysis

目的了解维持性血液透析患者的死亡原因及相关影响因素。方法选取2012年10月-2015年6月在我院透析中心维持性血液透析的死亡患者59例(死亡组),同时选取同期维持性血液透析存活患者59例作对照(对照组)。比较两组血尿素氮、血肌酐、血红蛋白、血浆白蛋白、总胆固醇、三酰甘油、超敏C-反应蛋白、血钙、血磷、甲状旁腺素等指标,分析患者的死亡原因及死亡相关危险因素。结果 59例死亡患者中死于心血管疾病32例(54.24%),脑血管疾病12例(20.34%),全身衰竭10例(16.95%),感染3例(5.08%),消化道出血2例(3.39%)。死亡组患者的血浆白蛋白、血红蛋白水平明显低于对照组,超敏C-反应蛋白水平则高于对照组(均P<0.01)。Logistic回归分析显示,低血浆白蛋白、贫血及高磷血症是死亡的独立危险因素(P<0.05)。结论在维持性血液透析患者中,常见死亡原因包括心血管疾病、脑血管疾病及全身衰竭等,其中心血管疾病是透析患者的主要死亡原因。贫血、低蛋白血症及高磷血症是死亡的独立危险因素。

Objective To analyze the death causes and related influence factors of the patients with maintenance hemodialysis（MHD）. Methods 59 dead patients receiving hemodialysis（HD） in the affiliated hospital of Guangdong Medical University from Oct 2012 and Jun 2015 were enrolled in this study. And 59 survival patients during the same period were randomly selected as Control Group. Demographic data, hemodialysis age, death causes and laboratory parameters such as blood urea nitrogen（BUN）, serum creatinine（Scr）, hemoglobin（HGB）, serum albumin（ALB）, total cholesterol（CHOL）, triglycerides（TG）, high-sensitivity C- reactive protein（CRP）, calcium, phosphorus parathyroid hormone（PTH） were compared between two groups. And the death caused and associated risk factors were analyzed. Results The causes of 59 cases of death were cardiovascular disease（32 cases, 54.24%）, cerebral vascular disease（12 cases, 20.34%）, systemic failure（10 cases, 16.95%）, infection（3 cases, 5.08%） and gastrointestinal bleeding（2 cases, 3.39%）. The plasma albumin and hemoglobin in Death Group was significantly lower than that in Control Group, while the hypersensitivity C-reactive protein was quite the contrary（P〈0.01）, and there was statistical difference between them. Logistic regression analysis showed that low serum albumin, anemia and hyperphosphatemia were independent risk factors for death. Conclusion Of MHD patients, cardiovascular disease, cerebrvaxcular disease and systemic failure were the common death causes, and cardiovascular disease was the main cause. Anemia, hypoalbuminemia and hyperphosphatemia were independent risk factors for death.