78例血液透析艾滋病病人死亡的相关因素分析

Mortality-related risk factors of AIDS patients on hemodialysis

目的探讨血液透析艾滋病（AIDS）病人死亡的相关因素。方法收集南宁市第四人民医院2011年6月至2015年12月血液透析AIDS病人透析前的基线资料,并随访至2016年12月,采用kaplan-meier（KM）法对生存率进行估计,使用COX模型进行危险因素分析。结果共收集78例血液透析AIDS病人,透析6个月的生存率为85.81%,12个月生存率为64.54%,24个月生存率为51.71%。单因素COX分析发现,透析前尿素氮、体质指数（BMI）、血压、血清白蛋白、血红蛋白、抗病毒治疗是病人不同时期死亡的相关因素。Schoenfeld’s global test发现尿素氮与生存时间存在交互作用（t=7.08,P〈0.01）。多因素COX模型分析发现,高血压是病人全随访期死亡的危险因素,而HAART、高血清白蛋白、正常体重、超重或肥胖则是保护因素,高尿素氮是病人死亡的危险因素。尿素氮与时间交互项亦有统计学意义（β=-0.01,P〈0.01）。结论该地区维持性血液透析的AIDS病人生存率较低,掌握病人死亡的相关因素对其生存期的预判、透析过程中的管理具有重要意义。

Objective To explore the risk factors of all cause mortality in AIDS patients with maintenance hemodialysis.Methods All AIDS patients in our hospital receiving maintenance hemodialysis from June 1 st,2011 to December 31 st,2015 were included and followed up prospectively until December 31 st,2016.Patients＇ survival was examined by Kaplan-Meier method,and mortality risk factors were examined by using COX regression models.ResultsThe survival rate was 85.81%,64.54% and 51.71% respectively for 6 months,12 months and 24 months.The univariate COX model showed that BUN,BMI,hypertension,ALB,HGB and HAART were risk factors for death.Schoenfeld＇s global test showed significant interaction between BUN and survival time.The multiple COX regression model indicated that BUN,BMI,hypertension,ALB and HAART were death related risk factors,and BUN and time interaction was still significant（β=-0.01,P〈0.01）.Conclusion Low survival rate is found in the study subjects.Clinical practice suggests that it is important to understand the mortality risk factors both for lifetime estimation and management of AIDS hemodialysis patients.