维持性血液透析145例死亡前1年内生化指标变化特征研究

Changes of biochemical indicators in maintenance hemodialysis patients before death

目的探讨维持性血液透析(MHD)患者死亡前1年内生化指标的变化特征。方法选择2008-01-01—2017-12-31在南京总医院国家肾脏疾病临床医学研究中心进行常规透析,年龄≥18岁且透析龄≥3个月死亡的患者为研究对象,按死亡原因分为心脑血管疾病死亡组(CCVD组)和非心脑血管疾病死亡组(non-CCVD组)两组,对死亡前1年内的每3个月生化指标进行回顾性分析,观察两组实验室指标变化。结果共纳入145例患者,其中男80例,女65例;死亡时年龄中位数71岁;CCVD组74例,non-CCVD组71例。CCVD组患者血清白蛋白(Alb)及肌酐(Cr)均维持在较高水平,死亡前1个月血磷上升。CCVD组患者死亡前9个月、6个月血钙达标率低,死亡前12个月到6个月血钙>2.5 mmol/L的比例高。死亡前6个月到1个月血磷>1.78 mmol/L比例高。non-CCVD组Alb及Cr维持较低水平,Cr下降早、下降幅度大,死亡前3个月、1个月血磷<1.13 mmol/L比例高。因感染死亡患者Alb在死亡前6个月开始显著下降,在6个月内下降了8.57%;因恶病质综合征、肿瘤死亡患者1年内Alb分别持续低于38 g/L和36 g/L。结论不同死亡原因MHD患者死亡前1年内血肌酐、血钙磷、血清白蛋白等指标的变化呈现不同特征性变化。

Objective To explore changes of biochemical indicators in maintenance hemodialysis patients in the last year of their survival.Methods Maintenance hemodialysis patients died from January 1,2008 to December 31,2017 were screened for enrollment.They were divided into two groups according to the cause of death:CCVD group and non-CCVD group.For the enrolled patients,biochemical indexes were performed every 3 months within one year before the end of life.Results A total of 145 cases(80 males,65 females,median age of death at age 71)were included.Patients were divided into two groups according to the causes of death:74 cases died of cardio-cerebrovascular diseases(CCVD group)and 71 cases died of non-cardio-cerebrovascular diseases(non-CCVD group).Serum albumin and creatinine concentration were maintained at high levels in the CCVD group and serum phosphorus increased one month before death.The serum calcium compliance rate in the CCVD group was significantly lower than that in the non-CCVD group at 9 months and 6 months before death.The proportion of patients with serum calcium >2.5 mmol/L at 12 th-6 th month before death and with serum phosphorus >1.78 mmol/L at 6 th-1 st months before death was higher than that of non-CCVD group.Serum albumin and creatinine concentration remained lower level and the later decreased early and significantly in the non-CCVD group.The proportion of patients with serum phosphorus <1.13 mmol/L was higher than that of the CCVD group at 3 months and one month before death.Serum albumin in patients who died from infective diseases began to decline significantly at the time of 6 months before death and decreased by 8.57% during 6 months.Serum albumin was consistently lower than 38 g/L and 36 g/L in patients who died from cachexia syndrome and tumor respectively in the last year before death.Conclusion Serum creatinine concentration,serum calcium,serum phosphorus,serum albumin and other indicators of MHD patients with different death causes within the last year of survival presented characteristic changes.