维持性血液透析患者全因死亡的影响因素分析

Analysis of the influencing factors of all-cause mortality in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者全因死亡的影响因素。方法选取2020年1月至2022年6月福建省立医院血液净化科收治的83例MHD患者作为研究对象,按照患者存活情况分为存活组(62例)和死亡组(21例),比较两组的基础资料、血常规、生化等指标,分析MHD患者全因死亡的影响因素。结果MHD患者死亡组的年龄、白细胞计数、中性粒细胞计数、红细胞分布宽度(RDW)、血小板分布宽度、中性粒细胞/淋巴细胞比值(NLR)、碱性磷酸酶、血钙均高于存活组,透析时间长于存活组,淋巴细胞计数、红细胞比容、血红蛋白、白蛋白、高密度脂蛋白、肌酐水平均低于存活组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,NLR(OR=1.486,95%CI=1.049~2.107,P=0.026)、RDW(OR=2.231,95%CI=1.055~4.716,P=0.036)、白细胞计数(OR=1.767,95%CI=1.082~2.887,P=0.023)、透析时间(OR=1.023,95%CI=1.004~1.041,P=0.017)是MHD患者全因死亡的独立危险因素,白蛋白(OR=0.76,95%CI=0.623~0.928,P=0.007)是MHD患者全因死亡的保护因素。结论NLR、RDW、白细胞计数和透析时间是MHD患者全因死亡的危险因素,且白蛋白是MHD患者全因死亡的保护因素。

Objective To investigate the factors that affect all-cause mortality in maintenance hemodialysis(MHD)patients.Methods A total of 83 MHD patients admitted to the Department of Blood Purification in Fujian Provincial Hospital from January 2020 to June 2022 were selected as the study objects.According to the survival status of the patients,they were divided into a survival group(62 cases)and a death group(21 cases).The basic data,blood routine,biochemical and other indicators of the two groups were compared to analyze the influencing factors of all-cause death in MHD patients.Results The age,white blood cell count,neutrophil count,red blood cell distribution width(RDW),platelet distribution width,neutrophil-to-lymphocyte ratio(NLR),alkaline phosphatase and blood calcium in the death group of MHD patients were all higher than those in the survival group,and the dialysis time was longer than that in the survival group,lymphocyte count,hematocrit,hemoglobin,albumin,high-density lipoprotein and creatinine were all lower than those in survival group,with statistical significances(P<0.05).Multivariate logistic regression analysis showed that NLR(OR=1.486,95%CI=1.049-2.107,P=0.026),RDW(OR=2.231,95%CI=1.055-4.716,P=0.036),white blood cell count(OR=1.767,95%CI=1.082-2.887,P=0.023),dialysis time(OR=1.023,95%CI=1.004-1.041,P=0.017)were independent risk factors for all-cause death in MHD patients,albumin(OR=0.76,95%CI=0.623-0.928,P=0.007)was a protective factor for all-cause death in MHD patients.Conclusion NLR,RDW,white blood cell count and duration of dialysis are risk factors for all-cause mortality in patients with MHD,and albumin is a protective factor against all-cause mortality in patients with MHD.