单中心20年间维持性血液透析患者死亡原因分析

Analysis of the causes of death in maintenance hemodialysis patients： a 20-year single-center study

目的分析我中心20年间血液透析患者死亡原因及长期生存率，比较了老年患者及糖尿病肾病（DN）患者预后。方法收集1996--2016年开始维持性血液透析（MHD）的患者。记录患者性别、年龄、原发病、开始血液透析时间及导致死亡的直接原因。结果收集317例患者。心源性疾病、感染和脑血管意外是前三位主要死亡原因。老年患者（≥60岁）的平均透析龄较非老年患者短[（51．8±45．7）个月比（81．6±66．5）个月，t=4．271，P=0．000]，且生存率低（x2=32．422，P=0．000）。DN患者的平均透析龄明显低于非DN患者[（44．1±33．8）个月比（69．4±60．6）个月，t=3．632，P=0．000]。DN患者生存率较非DN患者更低（x2=13．361，P=0．000）。整体5年生存率59．8%，10年生存率33．3％，20年生存率8．4％。结论我单位血液净化中心MHD患者长期生存率与发达国家及北京地区其他医院基本持平。前三位死亡原因分别为心源性疾病、感染和脑血管意外。对于老年和DN患者来说，总体预后较差。

Objective To analyze the causes of death of maintenance hemodialysis （MHD） patients, and to compare the long terra survival rate between elderly patients and non-elderly patients and between diabetic nephropathy （DN） patients and non-DN patients at our hemodialysis center during last 20 years. Methods A total of 317 MHD patients were collected,and divided into elderly （≥60 years） and non-elderly （〈60 years） groups based on the age at starting hemodialysis. Besides, data of gender, primary diseases, and the direct cause of death in maintenance hemodialysis patients from 1996 to 2016 were collected. Results Cardiogenic diseases, infections, and cerebrovascular accidents were the three leading causes of death. The mean dialysis age was shorter in elderly MHD patients than in non-elderly MHD patients[（51.8 ± 45.7） months vs. （81.6 ± 66.5） months, t = 4. 271,P=0. 000]with a lower survival rate （x2= 32. 422,P = 0. 000）. The mean dialysis age was significantly lower in DN patients than in non-DN patients[（44.1 ±33.8） months vs. （69.4±60.6） months,t= 3. 632, P = 0. 000）] with a lower survival rate （x2 = 13.361, P = 0. 000）. The overall survival rate was 59.8% after the fifth year of MHD,was 33.3% after the 10th year,was 8.4% after the 20th year,in our dialysis center. Conclusions The long-term survival rate of patients receiving maintenance hemodialysis in our center is as high as that in the developed countries and in other hospitals in Beijing. The top three death causes are cardiac diseases, infections, and cerebrovascular accidents. For old or DN patients,the overall prognosis is poor.