维持性血液透析患者的COX生存分析

Survival Analysis of Maintenance Hemodialysis Patients

摘要: 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。

Abstract: 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 < 0.05), diabetes mellitus (HR = 2.209, P < 0.05), hyperkalemia (HR = 2.757, P < 0.05), hyperuricemia (HR = 1.980, P < 0.05), anemia (HR = 2.490, P < 0.05 and high C-reactive protein level (HR = 1.005, P < 0.05) were independent risk factors affecting the survival time of MHD patients. Conclusion: The patients with older age at the beginning of dialysis, complicated with diabetes, hyperkalemia, hyperuricemia, anemia and inflammatory state have higher mortality. Active treatment of underlying diseases, strengthening the prevention and treatment of complications, correcting the levels of hyperglycemia, hyperkalemia and uric acid before dialysis, and improving anemia and inflammation can improve the long-term survival rate and prolong the survival time of uremic MHD patients.