维持性血液透析患者的临床流行病学变迁

目的 分析血液透析患者的流行病学特点,为提高其治疗水平和改善预后提供依据.方法 将死亡作为观察终点,回顾性调查分析于1991年6月至2011年6月维持性血液透析＞3个月的死亡患者临床资料,按时间顺序将患者分为1991年6月至2001年6月和2001年7月至2011年6月两组,比较两组血液透析患者的流行病学变迁.结果 ①原发病构成比中糖尿病肾病由10年前的15.7％增加到近10年的24.5％(x2=4.85,P＜0.05),高血压肾病由10年前的11.9％增加到近10年的17.9％(x2=3.97,P＜0.05).而慢性肾小球肾炎由10年前的44.0％下降到近10年的38.4％(x2=5.67,P＜0.05),慢性间质性肾炎由10年前的18.2％下降到近10年的13.1％ (x2=6.89,P＜0.05).②透析患者平均发病年龄由10年前的47.1±14.4岁增加到近10年的55.6±17.1岁,(F=14.97,P＜0.05);60岁以上患者构成比由10年前的40.8％增加到近10年的49.1％ (x2=7.21,P＜0.05) 30岁以下患者构成比由10年前的19.3％下降到近10年的15.6％ (x2=3.87,P＜0.05).③平均透龄由10年前的39.7±13.4个月延长到48.6±15.1个月(F=61.93,P＜0.05),透龄大于60个月患者构成比由10年前的20.1％增加到近10年的38.9％ (x2=18.71,P＜0.05),小于12个月患者构成比由10年前的20.5％减少到近10年的13.2％(x2=3.63,P＜0.05).④近10年血管通路呈现多样化改变,仍以自体动静脉内瘘为主,同时有较多患者使用长期性中心静脉导管和人工血管移植内瘘.首次透析动静脉内瘘的使用率由10年前12.5％提高到近10年的23.2％(x2=7.371,P＜0.05).⑤心脑血管事件导致死亡的构成比由10年前的53.5％上升到近10年的78.2％ (x2=29.576,P＜0.05).,感染引起死亡的构成比由10年前的37.1％下降到近10年的16.6％ (x2=23.70,P＜0.05). 结论 维持性血液透析患者的流行病学已发生明显变化,①原发病变迁:由原发性肾脏疾病向继发性肾脏疾病转变.②发病年龄的变迁:发病年龄由青年向老年转变.③透龄的变迁:患者平均透龄增大,生存期延长.,④血管通路变迁:血管通路呈现多样化,首次透析动静脉内瘘使用率增加.⑤死亡原因变迁:导致透析患者的死亡原因构成比中,心脑血管事件增多,感染减少.

The changes of epidemiological features in patients on maintenance hemodialysis

Objective To reveal the epidemiological features of patients treated with maintenance hemodialysis (MHD) for the improvement of their therapeutic effect and prognosis. Methods Patients treated with MHD for more than three months during the period of June, 1991 to June, 2011 were retrospectively analyzed. Patients were divided into two groups according to their death time. Their epidemiological features were studied. Results Epidemiological features in the recent 10 years were compared with those of 10 years ago. (a) MHD due to diabetic nephropathy rose significantly from 15.7% to 24.5% (x2=4.85, P<0.05). MHD due to hypertensive nephropathy increased from 11.9% to 17.9% (x2=3.97, P<0.05). On the other hand, MHD due to chronic glomerulonephritis decreased significantly from 44.0% to 38.4% (x2=5.67, P<0.05), and MHD due to chronic interstitial nephritis decreased from 18.2% to 13.1% (x2=6.89, P<0.05). (b) The age when MHD started rose significantly from 47.1?4.4 years to 55.6?7.1 years (F=14.97, P<0.05). The proportion of MHD patients more than 60 years old increased from 40.8% to 49.1% (x2=7.21, P<0.05), and the proportion of MHD patients less than 30 years old decreased from 19.3% to 15.6% (x2=3.87, P<0.05). (c) Dialysis age also prolonged significantly from 39.7?3.4 months to 48.6?5.1 months (F=61.93, P<0.05). MHD patients with dialysis age of more than 60 months rose from 20.1% to 38.9% (x2=18.71, P<0.05), and MHD patients with dialysis age of less 12 months decreased from 20.5% to 13.2% (x2=3.63, P<0.05). (d) Vascular access varied in recent 10 years. Autogenous arteriovenous fistula was used for most patients. Long-term central venous catheter and artificial vascular graft fistula were used increasingly. MHD patients using autogenous arteriovenous fistula as the first vascular access increased from 12.5% to 23.2% (x2=7.371, P<0.05). (e) Death due to cardiovascular and cerebrovascular events increased significantly from 53.5% to 78.2% (x2=29.576, P<0.05), and infection caused death decreased from 37.1% to 16.6% (x2=23.70, P<0.05). Conclusion In the recent 10 years, the primary diseases leading to MHD transformed from primary renal diseases to secondary renal diseases, the age when MHD started became older, average dialysis age prolonged, survival rate improved, vascular access approaches became varied, patients using arteriovenous fistula as the first vascular access increased, cardiovascular and cerebrovascular events were the leading causes leading to death, and death due to infection decreased. [