中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
Chinese Journal of Nephrology
2015年
9期
652-657
,共6页
马惠娟%唐骅%吕凛生%王燕妮%王彩霞%刘迅%娄探奇
馬惠娟%唐驊%呂凜生%王燕妮%王綵霞%劉迅%婁探奇
마혜연%당화%려름생%왕연니%왕채하%류신%루탐기
肾透析%危险因素%心血管疾病%依时协变量Cox回归
腎透析%危險因素%心血管疾病%依時協變量Cox迴歸
신투석%위험인소%심혈관질병%의시협변량Cox회귀
Renal dialysis%Risk factors%Cardiovascular diseases%Time?dependent Cox regression
目的 分析影响维持性血液透析患者心脑血管并发症预后的相关因素. 方法 研究对象为2009年1月1日至2014年12月31日在中山大学附属第三医院进行维持性血液透析超过3个月患者,记录患者入组时基线及每年度变化的透析相关指标、实验室指标及相关用药情况,随访至出现心脑血管事件或死亡,采用Cox比例风险回归和依时协变量Cox回归分析患者预后的影响因素. 结果 共入组243例维持性血液透析患者,年龄(53.2±16.4)岁,男性138例(56.8%).经混杂因素调整后,入组基线年龄增长(HR=1.040 ,95%CI:1.015~1.065 , P=0.002)、红细胞生成素剂量减少(HR=0.914 ,95%CI:0.846~0.987 ,P=0.022)以及透析治疗开始前合并心脑血管病史(HR=4.045 ,95%CI:2.074~7.890 ,P<0.001)是患者心脑血管预后的独立影响因素.经过基线独立影响因素调整后,血磷升高(HR=1.722 ,95%CI:1.034~2.866 ,P=0.037)是患者心脑血管预后的独立依时影响因素. 结论 年龄增长、红细胞生成素剂量减少和透析治疗开始前合并心脑血管病史是维持性血液透析患者心脑血管预后的独立危险因素.血磷升高是维持性血液透析患者心脑血管预后的依时协独立危险因素.
目的 分析影響維持性血液透析患者心腦血管併髮癥預後的相關因素. 方法 研究對象為2009年1月1日至2014年12月31日在中山大學附屬第三醫院進行維持性血液透析超過3箇月患者,記錄患者入組時基線及每年度變化的透析相關指標、實驗室指標及相關用藥情況,隨訪至齣現心腦血管事件或死亡,採用Cox比例風險迴歸和依時協變量Cox迴歸分析患者預後的影響因素. 結果 共入組243例維持性血液透析患者,年齡(53.2±16.4)歲,男性138例(56.8%).經混雜因素調整後,入組基線年齡增長(HR=1.040 ,95%CI:1.015~1.065 , P=0.002)、紅細胞生成素劑量減少(HR=0.914 ,95%CI:0.846~0.987 ,P=0.022)以及透析治療開始前閤併心腦血管病史(HR=4.045 ,95%CI:2.074~7.890 ,P<0.001)是患者心腦血管預後的獨立影響因素.經過基線獨立影響因素調整後,血燐升高(HR=1.722 ,95%CI:1.034~2.866 ,P=0.037)是患者心腦血管預後的獨立依時影響因素. 結論 年齡增長、紅細胞生成素劑量減少和透析治療開始前閤併心腦血管病史是維持性血液透析患者心腦血管預後的獨立危險因素.血燐升高是維持性血液透析患者心腦血管預後的依時協獨立危險因素.
목적 분석영향유지성혈액투석환자심뇌혈관병발증예후적상관인소. 방법 연구대상위2009년1월1일지2014년12월31일재중산대학부속제삼의원진행유지성혈액투석초과3개월환자,기록환자입조시기선급매년도변화적투석상관지표、실험실지표급상관용약정황,수방지출현심뇌혈관사건혹사망,채용Cox비례풍험회귀화의시협변량Cox회귀분석환자예후적영향인소. 결과 공입조243례유지성혈액투석환자,년령(53.2±16.4)세,남성138례(56.8%).경혼잡인소조정후,입조기선년령증장(HR=1.040 ,95%CI:1.015~1.065 , P=0.002)、홍세포생성소제량감소(HR=0.914 ,95%CI:0.846~0.987 ,P=0.022)이급투석치료개시전합병심뇌혈관병사(HR=4.045 ,95%CI:2.074~7.890 ,P<0.001)시환자심뇌혈관예후적독립영향인소.경과기선독립영향인소조정후,혈린승고(HR=1.722 ,95%CI:1.034~2.866 ,P=0.037)시환자심뇌혈관예후적독립의시영향인소. 결론 년령증장、홍세포생성소제량감소화투석치료개시전합병심뇌혈관병사시유지성혈액투석환자심뇌혈관예후적독립위험인소.혈린승고시유지성혈액투석환자심뇌혈관예후적의시협독립위험인소.
Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease (CCVD) in maintenance hemodialysis (MHD) patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 3rd Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1st, 2009 to Dec 31st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of (53.2 ± 16.4) years old, and 138 of them were male (56.8%). The multivariate Cox proportional model revealed that age (HR=1.040, 95%CI:1.015-1.065, P=0.002), Erythropoietin (EPO) dose (HR=0.914, 95%CI: 0.846-0.987, P=0.022) and history of cardiovascular and cerebrovascular disease (HR=4.045, 95%CI: 2.074-7.890, P<0.001) were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time-dependent serum phosphorus level (HR=1.722, 95%CI: 1.034-2.866, P=0.037) was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovascular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.
