尿毒症规律血液透析患者脑出血危险因素分析

Risk factors of cerebral hemorrhage in uremic patients on regular hemodialysis

目的探讨尿毒症规律血液透析患者脑出血发生的危险因素。方法回顾性分析2012年1月至2020年6月青岛大学附属医院及其附近医院收治的尿毒症规律血液透析发生脑出血患者(脑出血组)44例,随机选取同时段尿毒症规律血液透析未发生脑出血患者(对照组)224例,比较两组一般资料及实验室指标。采用独立样本t检验、χ^(2)检验、Mann-Whitney U检验及Logistic回归分析处理数据,绘制危险因素列线图,建立临床预测模型。结果多因素Logistic回归分析结果显示,高血清钙、低血清钠、高白细胞计数、高日常血液透析时收缩压、脑出血事件前收缩压、既往高血压病史、既往脑血管事件史、原发病为多囊肾、日常应用华法林为尿毒症规律血液透析患者脑出血的独立危险因素;基于上述危险因素构建尿毒症规律血液透析患者脑出血发生风险的列线图预测模型,校正曲线提示模型准确度良好。结论高血清钙、低血清钠、高血白细胞计数、高日常血液透析时收缩压、脑出血事件前收缩压、既往高血压病史、既往脑血管事件史、原发病为多囊肾、日常应用华法林为尿毒症规律血液透析患者发生脑出血的独立危险因素,列线图对尿毒症规律血液透析患者发生脑出血的风险评估有一定的临床价值。

Objective To explore the risk factors of cerebral hemorrhage in uremic patients on regular hemodialysis.Methods Totally 44 uremic patients with cerebral hemorrhage on regular hemodialysis(cerebral hemorrhage group)admitted to the Affiliated Hospital of Qingdao University and other surrounding hospitals from January 2012 to June 2020 were analyzed retrospectively,224 uremic patients on regular hemodialysis without cerebral hemorrhage in the same period were randomly enrolled(control group).The general data and laboratory indicators between groups were analyzed.Data was addressed with independent sample t-test,chi-square test(χ^(2) test),Mann-Whitney U-test and Logistic regression analysis,the nomogram for predicting factor was drawn to establish clinical prediction model.Results The results of multivariate logistics regression analysis showed that the independent risk factors for uremic patients with cerebral hemorrhage on regular hemodialysis were high serum serum calcium,low serum sodium,high white blood cell count,high systolic blood pressure on daily regular hemodialysis,systolic blood pressure before cerebral hemorrhage events,previous history of hypertension and cerebrovascular events,primary polycystic kidney disease,daily intervention by warfarin.Based on the above risk factors a nomogram for prediction model factor of risk of cerebral hemorrhage in patients with uremia on regular hemodialysis was established,and the correction curve showed good accuracy of the model.Conclusion The independent risk factors for uremic patients with cerebral hemorrhage on regular hemodialysis were high serum calcium,low serum sodium,high white blood cell count,high systolic blood pressure on daily regular hemodialysis,systolic blood pressure before cerebral hemorrhage events,previous history of hypertension and cerebrovascular events,primary polycystic kidney disease,daily intervention by warfarin,and the nomogram has certain clinical value for the risk assessment of uremic patients with cerebral hemorrhage on regular hemodialysis.