维持性血液透析患者的COX生存分析

Survival Analysis of Maintenance Hemodialysis Patients

目的:探讨影响维持性血液透析(maintenance hemodialysis, MHD)患者远期生存的因素,以期提高MHD患者的生存率和生存质量。方法:回顾性分析2010年~2020年青岛市中心医院血液净化中心确诊为终末期肾病(end stage renal disease, ESRD)并行血液透析治疗超过3个月的296名患者的生存情况,并就透析前病历资料对生存率的影响进行了分析。采用回顾性病例对照分析方法,根据终点事件将患者分为存活组和死亡组收集两组患者开始接受MHD时的各项临床及生化指标;采用单因素、多因素COX回归分析MHD远期死亡的主要原因及相关危险因素。结果:296例患者1年、3年、5年、10年的累积生存率分别为:90.9%,80.1%,80.0%,63.8%,COX回归分析结果显示:开始透析年龄 ≥ 60岁(HR = 2.415, P 【0.05)、合并糖尿病(HR = 2.209, P 【0.05)、高血钾(HR = 2.757, P 【0.05)、高尿酸血症(HR = 1.980, P 【0.05)、贫血(HR = 2.490, P 【0.05)、高C反应蛋白水平(HR = 1.005, P 【0.05)为影响MHD患者生存时间的独立危险因素。结论:开始透析年龄较大、合并糖尿病、高血钾、高尿酸血症、贫血、炎症状态的患者死亡率高。积极治疗基础病、加强合并症防治、纠正透析前高血糖、高血钾和高尿酸水平,改善贫血和炎症状态能提高尿毒症MHD患者的长期生存率,延长生存时间。

Objective: To explore the factors affecting the long-term survival of maintenance hemodialysis (maintenance hemodialysis, MHD) patients in order to improve the survival rate and quality of life of MHD patients. Methods: The survival conditions of 296 patients diagnosed with end-stage renal disease (end stage renal disease, ESRD) and hemodialysis for more than 3 months in the Blood purification Center of Qingdao Central Hospital from 2010 to 2020 were analyzed retrospectively, and the effect of pre-dialysis medical records on survival rate was analyzed. The patients were divided into the survival group and the death group according to the end events by retrospective case-control analysis, the clinical and biochemical indexes of the two groups at the beginning of MHD were collected, and the main causes and related risk factors of long-term death of MHD were analyzed by univariate and multivariate COX regression. Results: The cumulative survival rate of 296 patients at 1 year, 3 years, 5 years and 10 years was 90.9%, 80.1%, 80.0% and 63.8%, respectively. The results of COX regression analysis showed that the age of starting dialysis ≥ 60 years old (HR = 2.415, P