维持性血液透析后血清尿素反弹及其影响因素

目的 研究观察维持性血液透析（MHD）患者透析后血清尿素反弹情况及相关影响因素。 方法 稳定的MHD患者124例为对象。取透析前、透析结束时、透析后15 min、30 min血样，定量观察尿素反弹及其对透析充分性指标单室尿素清除指数（spKt/V）和血清尿素下降率（URR）的影响。分析其与患者人口学特征、透析参数的相关关系。 结果 血液透析后的血清尿素反弹平均达13.6%，导致URR和spKt/V分别高估0.04和0.14。影响尿素反弹最重要的因素是透析效率K/V，此外还有较高的血红蛋白、较多的相对超滤量、动静脉通路和男性。 结论 血液透析后的尿素反弹普遍存在。对于特定的个体和透析过程，其对透析充分性指标的影响不能忽略。     

血清铁调素-25与维持性血液透析患者生存预后的关系研究

目的铁调素在铁代谢中起重要调节作用,抑制肠道铁吸收、肝细胞和巨噬细胞铁释放,但其临床应用价值尚不清楚。本研究旨在研究铁调素-25与维持性血液透析(MHD)患者生存预后的关系。 方法本研究为前瞻性观察性队列研究,选取2016年1月至2020年12月在徐州市中心医院血液净化中心的160例MHD患者,根据患者基线血清铁调素-25水平分为低水平组(<30.9 ng/ml)和高水平组(≥30.9 ng/ml),随访5年。采用Kaplan-Meier生存曲线、多因素Cox比例风险模型及基于限制性立方样条的Cox比例风险回归模型分析铁调素-25与死亡风险的关系。 结果与低水平组相比,高水平组患者的基线血清铁、铁蛋白、转铁蛋白饱和度(TSAT)、超敏C反应蛋白(hs-CRP)水平较高,透析前的血肌酐、白蛋白和前白蛋白水平较低。高水平组患者生存预后较差,透析龄较短(P＝0.0011),随访期死亡率较高(P＝0.0023)。血清铁调素-25增加10 ng/mL时,MHD患者全因死亡风险比为1.206(95%CI: 1.100~1.323, P<0.001)。MHD患者的全因死亡风险比在血清铁调素-25<30.9 ng/mL时相对稳定,在血清铁调素-25水平超过30.9 ng/mL之后,随着铁调素水平增加而显著升高。 结论血清铁调素-25水平可作为MHD患者全因死亡事件的独立预测因子,监测血清铁调素-25水平有助于预测MHD患者的生存预后。     

The relationship between survival rate and intradialytic blood pressure changes in maintenance hemodialysis patients

Objective: The objective of this study is to investigate the relationship between blood pressure changes and all-cause mortality, and between blood pressure changes and cardiovascular mortality, for maintenance hemodialysis (MHD) patients during dialysis.

Methods: Data regarding general condition, biochemical indices, and survival prognosis of MHD patients who were treated at the Shanghai Jiao Tong University School of Medicine-affiliated Renji Hospital from July 2007 to December 2012 were collected, in order to evaluate the relationship between patients’ blood pressure changes during hemodialysis and mortality.

Results: Among 364 patients, with an average age of 63.07?±?13.93?years, an average dialysis vintage of 76.00 (range, 42.25–134.00) months, and a follow-up time of 54.86?±?19.84?months, there were 85 cases (23.4%) of all-cause death and 46 cases (14.2%) of cardiovascular death. All-cause mortality and cardiovascular mortality were lowest (OR, 0.324 and 0.335; 95% CI, 0.152–0.692 and 0.123–0.911; p value, .004 and .032, respectively) in patients whose systolic blood pressure difference (ΔSBP) before and after dialysis was between 7.09 and 14.25?mmHg. Kaplan–Meier analysis indicated that both all-cause mortality and cardiovascular mortality were markedly increased for patients with ΔSBPless than ?0.25?mmHg (p value, .001 and .044, respectively). Cox regression analysis showed that ΔSBPKt/v and albumin were independent risk factors for all-cause mortality in MHD patients.

Conclusions: MHD patients whose blood pressure increased significantly after hemodialysis had a higher risk of dying; ΔSBP, hemoglobin concentration, Kt/v and albumin were independent risk factors for all-cause mortality in MHD patients.     

血液透析患者的感染及相关因素分析

目的 了解感染及相关因素与血液透析(血透)患者生存质量的关系。方法 对1997．1．1-2001．4．30间因感染住院的62例血透患者的临床资料进行回顾性分析，对感染部位、病原体、疗程、心胸比例及营养情况等进行比较统计。结果 62例血透患者共发生了72例次感染。感染部位主要为肺部(51．4％)和血管通路(16．7％)。病原学检查检出革兰氏阳性菌15例次，革兰氏阴性菌4例次，真菌8例次，混合感染10例次。患者平均Hb和Alb分别为72．5g/L和32．8g/L。抗感染平均疗程和住院天数分别为16d和26d。肺部和多部位感染患者中心胸比例，0．5者较多，肠道和肺部感染患者中糖尿病的比例较高。结论 血透患者感染菌种主要是革兰氏阳性菌，肺部感染的发生率较高。低血红蛋白水平及较差的营养状况可能加重了血透患者的免疫力低下状况。     

洛阳市维持性血液透析患者生活质量调查及影响因素分析

目的 通过对洛阳市维持性血液透析(maintenance hemodialysis,MHD)患者的生活质量进行调查,分析影响MHD患者生活质量的因素,为改善MHD患者生活质量提出依据.方法 采用质量调查问卷(Short-Form 36 Health Survey Questionnaire,SF-36)生活质量量表对洛阳市第一人民医院、洛阳市中心医院、河南科技大学第一附属医院、河南科技大学第三附属医院、解放军150医院、洛阳市第一中医院、洛阳市第二中医院352例MHD患者进行问卷调查,计算血液透析患者生活质量得分,与健康常模进行比较,分析影响MHD患者生活质量的因素.结果 研究组患者SF-36量表8个维度的得分显著低于健康常模(P＜0.05).MHD患者生活质量与性别、年龄、透析龄、血红蛋白、透析充分性(Kt/V)等因素有关.结论 MHD患者生活质量明显低于健康人群,年龄、性别、透析龄、血红蛋白、Kt/V是影响MHD患者生活质量的重要因素,改善这些因素有望提高MHD患者的生活质量.     

维持性血液透析患者血管钙化的发生情况及相关危险因素分析

目的探讨维持性血液透析患者的血管钙化发生情况及相关危险因素分析。方法选择血液透析患者91例,记录相关人口学资料及临床资料,完善实验室检查。分别以X光片（腰椎侧位、双手、骨盆）评价血管钙化情况。结果91例患者中无血管钙化者22例,有不同程度血管钙化者69例;轻度钙化38例（占41．76％）,中度钙化14例（占19．72％）,重度钙化17例（占23．94％）;统计学分析显示2组间年龄、血磷和钙磷乘积有统计学差异（P〈0．05）;单因素分析显示年龄、血磷、钙磷乘积和未服用活性维生素D是血管钙化的危险因素,多因素分析显示年龄、血磷、未服用活性维生素D为血管钙化独立影响因素。结论血管钙化是维持性血液透析患者常见并发症,且发病率较高,高龄、高磷血症、高钙磷乘积及合理使用活性维生素D在钙化发生、发展中有重要作用。     

维持性血液透析患者动脉粥样硬化的早期诊断及相关因素研究

显著的影响.MHD患者桡动脉内膜厚度显著厚于对照组(P＜0.05),与颈动脉IMT呈正相关(P＜0.01).有斑块患者IMT及心血管并发症的发生率高于无斑块患者(P＜0.01).结论 MHD患者颈动脉粥样硬化发生率高,微炎症状态是其发生的重要影响因素.     

血液透析患者血清脂肪因子水平及相关因素初步观察

目的 探讨维持性血液透析患者血清脂肪细胞因子脂联素、瘦素、抵抗素的水平、相关影响因素及相互关系.方法 维持性血液透析患者79例,正常对照组16名.测定2组患者血清脂联素、瘦素、抵抗素、白蛋白、血脂等.分析脂联素、瘦素、抵抗素与这些参数的相关性.结果 维持性血液透析患者甘油三酯、脂联素、瘦素、抵抗素分别为(1.9±0.9)mmol/L、(14±9)mg/L、(105±109)g/L、(0.89±0.33)ng/ml,对照组分别为(1.4±0.5)mnloL/L、(6±4)mg/L、(52±19)异/L、(0.44±0.20)ng//ml,两组比较差异有统计学意义(P<0.05、0.01),而白蛋白(38±4)g/L、高密度脂蛋白(1.3±0.3)mmol/L与对照组[(43±6)g/L、(1.5±0.3)mmol/L]比较差异有统计学意义(P<0.05),维持性血液透析患者胆同醇(4.1±0.9)mmol/L、低密度脂蛋白(2.3±0.7)mmol/L与对照组((4.2±0.9)mmoL/L、(2.1±1.0)mmol/L]比较差异无统计学意义(P>0.05).多元逐步回归分析结果显示,体重指数、高密度脂蛋白、腰臀围比是血清脂联素的独立影响因素.性别和体重指数是血清瘦素的独立影响因素.血清抵抗素与各项临床资料、生化指标的相关性均无显著性.血清脂联素与瘦素呈显著负相关(r:0.232,P<0.01).结论 维持性血液透析患者脂联素、瘦素和抵抗素的水平可能是营养、脂代谢及心血管疾病之间的联系因子.     

维持性血液透析患者抑郁状态的相关因素分析

目的调查抑郁状态在维持性血液透析（maintenancehemodialysis,MHD）患者中的发生情况,探讨与抑郁相关的生理及社会因素,为进一步的心理干预做好前期工作。方法采用横断面调查,应用Zung抑郁自评量表对太仓市第一人民医院血液净化中心的102例MHD患者进行评估,根据患者是否合并抑郁状态分为非抑郁组（36例）和抑郁组（66例）。收集MHD患者的个人背景资料、临床资料、实验室数据以及问卷调查结果（以社会支持评定量表评分评估患者的社会支持程度,以营养不良-炎症评分评估患者的营养水平,以Charlson评分评估患者的合并症严重程度）,采用SPSS13．0软件进行统计分析,探讨与抑郁状态相关的因素。结果102例MHD患者中,合并抑郁症的患者66例,发生率为64．7％,仅6例（占9％）的抑郁症患者曾主动寻求过医疗帮助。非抑郁组与抑郁组比较,年龄、营养不良一炎症评分、Charlson指数、C反应蛋白水平偏低（P〈0．05）,而血白蛋白、社会支持评定量表评分、收入情况、有配偶的比例较高（P〈0．05）。进一步行多重线性回归分析发现,年龄、收入情况、Charlson指数、C反应蛋白均可独立的在不同程度上影响Zung抑郁自评量表评分,收入情况为影响Zung抑郁自评量表评分的最主要因素。结论MHD患者的抑郁症发病率较高,主动求医率低,年龄、收入水平、合并症的严重程度、C反应蛋白均为影响MHD患者抑郁程度的独立危险因素,而收入情况可能对抑郁程度的影响最大。     

维持性血液透析患者血清脂联素与营养状况的关系

目的探讨维持性血液透析患者血清脂联素与营养状况的关系。方法对81例维持性血液透析患者应用改良定量主观全面营养评估（MQSGA）法、血生化指标、人体指数学指标综合评估其营养状况,同时采用ELISA法测定血清脂联素水平,评估血清脂联素与营养状况之间的相关性。结果维持性血液透析患者营养不良患病率为69．1％。血清脂联素平均为（8．66±2．62）μg／ml,与MQSOA、肱三头肌皮褶厚度、上臂肌围、腰臀比、体重指数等营养指标成线性相关关系。结论维持性血液透析患者大多存在不同程度的营养不良,血清脂联素水平与营养指标相关,可作为评估血液透析患者营养不良的指标之一。     

维持性血液透析患者认知功能障碍相关因素分析

目的 评估维持性血液透析(maintenance hemodialysis,MHD)患者认知功能障碍(cognitive impairment,CI)的发生率及CI发病与非传统危险因素的相关性.方法 MHD患者140例,采用蒙特利尔认知评估量表(montreal cognitive assessment scale,MoCA)行认知功能评分,横断面调查年龄、性别、受教育年限、原发病与合并症等临床数据,检测超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白蛋白、高半胱氨酸(homocysteine,Hcy)、血红蛋白等实验室指标.将患者分为CI组与无CI组,比较2组患者临床和实验室数据.结果 80例发生CI,发生率为57.1％.CI组患者MoCA平均得分为(18.70±2.74),糖尿病肾病的合并率为41.3％,hs-CRP为(13.6±7.6)mg/L,Hcy为(29.6±6.2)μmol/L.CI组的年龄大于60岁患者比率、透析年限、合并糖尿病肾病与高血压病比率、hs-CRP、Hcy明显高于无CI组(P＜0.05),CI组受教育年限、血红蛋白、白蛋白值显著低于无CI组(P＜0.05).Logistic回归分析显示,年龄、糖尿病肾病、血红蛋白、Hcy、hs-CRP是MHD患者CI的独立危险因素.结论 本研究MHD患者CI的发生率与国外研究结果相近.炎症、Hcy、贫血等非传统危险因素与MHD患者CI的发生相关.     

Survival of patients on maintenance hemodialysis: emphasis on incidence of cerebro- and cardiovascular diseases

Background. The overall survival rate and contributory factors were examined in patients undergoing hemodialysis in one dialysis program. The clinical profiles of dialysis patients who suffered from cerebro- and cardiovascular diseases (CCVD) were also studied. Methods. Data were available for 1064 patients who had received hemodialysis treatment for more than 3 months in our program (17 centers) in Miyazaki, Japan, between 1971 and 1994. Results. The respective 3-, 5-, and 10-year actuarial survival rates were 85%, 79%, and 66%. The Cox proportional hazard model identified three variables: age at start of hemodialysis (adjusted relative hazard [RH], 1.05), sex (RH, 1.42 for males), and type of underlying renal disease (RH, 1.00 for chronic glomerulonephritis, 2.80 for diabetes mellitus, 1.59 for nephrosclerosis), as being significantly associated with survival. Patients with CCVD had a high incidence of cerebral hemorrhage (8.7 per 1000 person-years). Patients whose first CCVD episode occurred within 36 months of starting hemodialysis were older, and more frequently had diabetes mellitus or nephrosclerosis and suffered from cerebral infarction. Long-term hemodialysis patients with CCVD more frequently had chronic glomerulonephritis as the underlying disease and had a higher incidence of cerebral hemorrhage. Conclusion. Age, sex, and underlying renal disease were independent factors that contributed to the mortality of the hemodialysis patients. There was a high incidence of CCVD among the hemodialysis patients, but the etiology of CCVD may differ depending on the underlying renal disease. Received: June 22, 1998 / Accepted: May 20, 1999     

Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis

We retrospectively investigated the incidence and prognosis of and risk factors for cerebrovascular events in 1,064 patients with chronic uremia who received maintenance hemodialysis (HD) for more than 3 months during 24 years in our dialysis units in Miyazaki, Japan. Cerebrovascular events developed in 98 patients (9.2%). The confirmed incidences of cerebral hemorrhage (CH) and infarction were 8.7 and 3.7 per 1,000 patient-years, respectively. Of the 56 patients with CH, 40 (71.4%) died within 3 months of the onset of CH. Ganglio-thalamic lesion was observed in 32 (80.0%) of 40 patients with CH confirmed by a brain computed tomography. The incidence of polycystic kidney disease was higher in the CH group than in the overall HD population (12.5% v 3.9%, P < 0.01). Of the 13 patients with diabetes mellitus and nephrosclerosis, nine (69.2%) developed CH within 36 months of the initiation of HD; 11 (78.6%) of 14 patients with chronic glomerulonephritis developed CH after 36 months. CH developed in six patients (15.0%) within 6 hours of a previous HD session. We compared laboratory values, the supine blood pressure, and electrocardiographic (ECG) findings in 35 patients with CH and a control group (66 patients) matched in age, sex, basal renal disease, age at the initiation of HD, and the duration of HD. Data were obtained before and after HD 3 to 4 months before the first attack of CH. The systolic and diastolic blood pressure (SBP, DBP) before and after HD were significantly higher in the CH group than in the control group (pre-HD SBP: 171 +/- 22.5 v 154 +/- 19.3 mm Hg, P < 0.001; pre-HD DBP: 89 +/- 13.6 v 81 +/- 9.6 mm Hg, P < 0.001). The incidence of left ventricular hypertrophy was higher, and the Kt/V was significantly lower (1.23 +/- 0.26 v 1.38 +/- 0.34, P < 0.05) in the CH group than in the control group. However, there were no significant differences in the serum levels of albumin and cholesterol or the total dose of heparin during HD sessions between groups. In conclusion, the incidence of CH was high, and its prognosis was poor, in patients undergoing maintenance HD. Reversible risk factors include hypertension and possibly the amount of HD prescribed, but not anticoagulation with heparin.     

盐酸司维拉姆治疗维持性血液透析患者高磷血症的短期疗效

目的 评价盐酸司维拉姆治疗终末期肾病维持性血液透析（MHD）患者高磷血症的短期疗效和安全性。 方法 来自国内5所综合性医院共138例并发高磷血症（透析前血磷＞1.78 mmol/L）的MHD患者纳入本研究。经过2周磷结合剂洗脱后,根据患者血磷水平予以相应口服剂量的盐酸司维拉姆片剂治疗,疗程为10周,随后为2周的停药观察期,总观察期为14周。给药期间每2周根据患者血清钙磷水平调整药物剂量。 结果 共有111例患者完成全部试验。经盐酸司维拉姆治疗2周后,患者血磷和血清钙磷乘积水平明显下降。10周疗程结束时,与用药前比较,患者血磷[（1.85±0.50）比（2.57±0.54） mmol/L,P < 0.01]、钙磷乘积[（4.16±1.72）比（5.79±1.50） mmol2/L2,P < 0.01]和血清低密度脂蛋白水平[（1.64±0.76）比（2.31±0.87） mmol/L,P < 0.01] 显著下降,而血浆全段甲状旁腺激素（iPTH）水平和血清校正血钙水平无显著变化。停药后2周,血磷和钙磷乘积水平高于10周治疗结束时,但仍显著低于基线水平[（2.26±0.7）比（2.57±0.54） mmol/L;（5.12±1.63）比（5.79±1.50） mmol2/L2,P < 0.01]。 纳入研究的138例患者中,106例（76.8%）发生了214件不良事件,其中89例（64.5％）的121件为不良反应。胃肠道不良事件总发生率为68.11%（94/138）,以轻至中度的便秘最为常见,经对症处理后可缓解或消失。 结论 盐酸司维拉姆可有效纠正终末期肾病MHD患者的高磷血症,并能降低血清钙磷乘积和血清低密度脂蛋白水平。用药后便秘等胃肠道症状较常见。     

Epileptic seizures in patients following allogeneic hematopoietic stem cell transplantation: a retrospective analysis of incidence,risk factors,and survival rates

The incidence of epileptic seizures among allogeneic hematopoietic stem cell transplant (allo‐HSCT) patients has been poorly described. No report has systematically studied epilepsy's possible causes, risk factors, and effect on prognosis among allo‐HSCT patients. We retrospectively examined data from 1461 patients who underwent allo‐HSCT within the past 6.5 yr at the Institute of Hematology and People's Hospital, Peking University. The cumulative incidence of all epileptic seizure complications was 7.1%. Of the 79 transplant patients who had epileptic seizures, 3 (3.8%) experienced a seizure during the conditioning stage, 52 (65.8%) between day 0 and day 100, 20 (25.3%) from day 100 to the first year, and 4 (5.1%) after the first year. Multivariate regression analysis identified the age of the recipient as (≤18 yr) (p < 0.001), donor type (p = 0.004), graft versus host disease (aGVHD) (p = 0.018), and hyponatremia (p = 0.003) as independent risk factors for epileptic seizures among allo‐HSCT patients. The median survival time of patients with epileptic seizures was 246 d after transplantation (ranging between 18 and 2170 d). Survival after one yr and 6.5 yr was significantly reduced in patients who developed epileptic seizure complications compared with those who did not (57.2% vs. 75.7% at one yr, p = 0.015, and 31.1% vs. 71.4% at five yr, p < 0.001). Of the 79 patients who experienced epileptic seizure complications, 53.2% died (n = 42). The survival rate of these patients was relatively low, and cerebrovascular disorders or central nervous system infection‐related epileptic seizures usually resulted in a high mortality and poor prognosis. A patient transplantation age which is younger than 18 yr, related mismatched transplants, aGVHD, and hyponatremia are risk factors for epileptic seizures in allo‐HSCT recipients. Epileptic seizures among allo‐HSCT patients are associated with a poor prognosis.     

血液透析患者动静脉内瘘栓塞及影响因素研究

目的探讨血液透析患者动静脉内瘘栓塞的影响因素。方法选取72例建立自体动静脉内瘘患者,应用超声稀释技术在入组2周内及3、6个月后对自体动静脉内瘘栓塞相关指标进行3次监测,然后随访观察6个月(共观察1年)。观察期间记录动静脉内瘘栓塞发生情况以及流量和再循环率的变化趋势,同时收集患者性别、年龄、内瘘使用时间、透析龄、平均动脉压、糖尿病病史、钙磷乘积、心输出量等资料。结果随访结束时18例发生栓塞,栓塞发生率为25.0%;18例3次监测的平均内瘘流量为(709.6±337.8)mL/min,其中13例第1次监测时内瘘流量500mL/min;第1次监测内瘘存在再循环的5例患者均发生栓塞。未发生栓塞的54例患者3次监测的内瘘流量为(1 171.7±692.9)mL/min,仅9例第1次监测时内瘘流量500mL/min。Logistic回归分析结果显示,再循环率、内瘘流量、钙磷乘积、糖尿病病史、心输出量是动静脉内瘘栓塞的影响因素(P0.05,P0.01)。结论定期监测血液透析患者动静脉内瘘栓塞相关指标,对内瘘栓塞的影响因素进行早期干预可防范内瘘栓塞的发生,延长内瘘使用寿命。     

维持性血液透析患者社会疏离感现状及影响因素研究

目的 了解维持性血液透析患者社会疏离现状并分析其影响因素。方法 便利选取249例维持性血液透析患者为研究对象,采用一般资料调查表、社会影响量表、家庭关怀量表、疾病接受度量表及一般疏离感量表进行调查。结果 维持性血液透析患者社会疏离感得分(37.83±9.83)分;多元线性回归分析结果显示,年龄、子女个数、婚姻状况、医疗费用支付方式、透析龄、歧视知觉总分、疾病接受度总分与家庭关怀度总分进入回归方程,可解释维持性血液透析患者社会疏离感57.60%的变异。结论 维持性血液透析患者社会疏离感处于中等偏上水平,医护人员可通过降低其歧视知觉水平、增加其疾病接受度和家庭关怀度,从而减轻患者社会疏离感水平。     

维持性血液透析患者高同型半胱氨酸血症的影响因素和大剂量叶酸治疗的效果

目的 观察慢性肾功能衰竭（CRF）维持性血液透析（HD）患者血浆总同型半胱氨酸（tHcy)的影响因素和大剂量叶酸治疗是否可以纠正其高同型半胱氨酸血症（HHcy)。方法 77例稳定的HD患者被分为4组，分别口服叶酸0、5、15或30mg/d，3个月以上（所有患者均不使用维生素B12），用放射免疫分析法测定透析前血浆叶酸，全血叶酸和维生素B12，用高效液相法测定透析前和部分患者透析后血浆总同型半胱氨酸（tHcy)。用常规方法测定总胆固醇（TC），甘油三酯（TG），高密度脂蛋白（HDL），低密度脂蛋白（LDL），血清白蛋白（Alb)，肌酐（Scr），尿素（Urea)。观察不同剂量的叶酸治疗对血浆和全血叶酸的影响。以及血浆和全血叶酸与tHcy的关系。结果 叶酸治疗可以明显提高血疗对血浆和全血叶酸的影响，以及血浆和全血叶酸与tHcy的关系。结果 叶酸治疗可以明显提高血浆和全血叶酸水平。血浆和全血叶酸水平呈线性正相关。血浆和全血叶酸与tHcy均呈非线性负相关，口服叶酸5-15mg/d均可使血浆叶酸大于200ng/ml，此时血浆和全血叶酸的进一步上升不引起tHcy的进一步下降，结论 对HD患者，治疗HHcy的叶酸的合适剂量是5-15mg/d，进一步增大叶酸剂量并不能使tHcy水平进一步下降，口服叶酸结合HD治疗不能完全纠正HD患者HHcy。