腹膜透析患者不同时期内死亡的危险因素分析

The risk factors of mortality in peritoneal dialysis patients in different periods

目的探讨影响腹膜透析患者不同时期内死亡的危险因素及病例特点。方法回顾性分析2005年11月1日至2017年2月28日南昌大学第一附属医院肾内科腹膜透析中心的新入腹膜透析患者的临床资料。根据患者死亡时间分为1年内死亡组和1年后死亡组。采用Cox比例回归模型分析影响两组患者死亡的危险因素。结果共纳入997例患者，死亡244例，其中1年内死亡组69例（28．3％），1年后死亡组175例（71．7％）。心脑血管疾病是1年内死亡组和1年后死亡组患者死亡的主要原因，分别占59．4％和51．4％。Cox回归分析结果显示，高龄（HR=I．035，95％CI为1．016-1．055，P〈0．001）、低血总钙（HR=0.167，95％CI为0．053～0．529，P=0.002）、低血白蛋白（HR=0.899，95％CI为0．856～0．943，P〈0．001）和低血载脂蛋白A1（HR=0.274，95％CI为0．095～0．789，P=0.016）是腹膜透析患者1年内死亡的危险因素；高龄（HR=1．053，95％CI为1．038～1．069，P〈0．001）、合并糖尿病（HR=2．181，95％CI为1．445～3．291，P〈0．001）、血三酰甘油升高（HR=1．204，95％CI为1．065～1．362，P=0.003）是腹膜透析患者1年后死亡的危险因素。结论腹膜透析患者1年内死亡及1年后死亡的危险因素不尽相同，高龄、低血钙、低血白蛋白、低血载脂蛋白A1是腹膜透析患者1年内死亡的独立危险因素，而高龄、合并糖尿病和高血三酰甘油是1年后死亡的独立危险因素。

Objective To explore the risk factors and characteristics in patients with peritoneal dialysis who died in different periods. Methods The clinical data of new peritoneal dialysis patients in the Department of Nephrology and Peritoneal Dialysis Center of the First Affiliated Hospital of Nanchang University from November 1, 2005 to February 28, 2017 was retrospectively analyzed. The patients were divided into two groups according to the time of death： those who died within one year and died after one year. The risk factors of mortality between the two groups were analyzed by Cox regression model. Results A total of 997 patients were enrolled and 244 patients died. There were 69 patients （28.3%） died within one year and 175 patients （71.7%） died after one year. Cardiovascular and cerebrovascular disease was the dominating reason of death in both groups, accounting for 59.4% （died within one year group） and 51.4% （died after one year group） respectively. Cox regression analysis showed that for died within one year group, old age （HR=1.035, 95% Ch 1.016-1.055, P〈 0.001）, low blood total calcium （HR=0.167, 95% CI： 0.053-0.529, P=0.002）, low albumin （HR=0.899, 95%CI： 0.856-0.943, P 〈 0.001） and low apolipoprotein A1 （HR=0.274, 95%CI： 0.095-0.789, P=0.016） were risk factors associated with mortality. However, for died after one year group, old age （HR=1.053, 95%CI： 1.038-1.069, P 〈 0.001）, combined with diabetes （HR=2.181, 95%CI： 1.445-3.291, P〈 0.001） and hypertriglyceride （HR=1.204, 95%CI： 1.065-1.362, P=0.003） were risk factors associated with mortality. Conclusions The risk factors of mortality for peritoneal dialysis patients of different periods were not exactly the same. For died within one year patients, old age, low blood total calcium, low albumin and low apolipoprotein A1 were independent risk factors for mortality. However, for died after one year patients, old age, combined with diabetes, and high triglycerides were independent risk factors for mortality.