终末期糖尿病肾病两种透析方式患者死亡原因分析

目的 分析终末期糖尿病肾病患者两种替代治疗的死亡原因,比较他们的死因差异,探寻防治方法.方法 回顾性分析该院2001年6月-2011年6月间接受血液透析（HD）和腹膜透析（PD）治疗的终末期糖尿病肾病死亡患者52例,比较两组平均动脉压、血浆白蛋白、血脂等生化指标,并分析他们的死亡原因,比较死亡差异和第1、2、3、4、5年的生存率.结果 HD组患者平均动脉压和血清白蛋白水平较PD组明显升高,甘油三酯水平较PD组低,两组比较差异统计学意义.血红蛋白、胆固醇及血肌酐、尿素氮水平两组相比无明显差异.PD组死于感染占55.56%,其次为心血管疾病11.11%.而HD组死因首位为心血管疾病36%,其次为感染24%,两组比较差异有统计学意义.两组的脑血管疾病、营养不良、消化道出血、恶性肿瘤和其他原因死亡率相当,无统计学意义.透析开始1、2年两组生存率相当,但2年后PD组生存率低于HD组,差异具有统计学意义.HD组存活4、5年的例数较PD组多,但无统计学差异.结论 终末期糖尿病肾病患者行替代治疗的两组死亡原因都以感染和心血管并发症为主.提示预防和及早控制感染及心血管并发症,有助于提高ESDN患者生存率.

Comparision of death causes between end-stage diabetic nephropathy patients undergoing hemodialysis and peritoneal dialysis

Objective To compare end-stage diabetic nephropathy patients causes of death by two groups respectively undergoing hemo-dialysis and peritoneal dialysis. Methods 52 dead patients with end-stage diabetic nephropathy from June 2001 to June 2011 were col-lected. They were divided into hemodialysis （HD） group and peritoneal dialysis （PD） group. Mean arterial pressure, plasma albumin, lipids, other biochemical parameters, causes of death, and 1,2,3,4,5-year survival rate were compared. Results HD group mean arterial pressure and serum albumin were significantly higher than group. HD group triglyceride was significantly lower than PD group. The two groups＇ hemoglobin, cholesterol, serum creatinine, blood urea nitrogen showed no significant difference. In PD group death of infection ac-counted for 55.56%, followed by 11.11% of cardiovascular disease. In HD group death of cardiovascular disease accounted for 36%, fol-lowed by 24% of infection. The differences between the two groups were statistically significant. The groups＇ death causes of cerebrovas-cular disease, malnutrition, gastrointestinal bleeding, cancer and other causes were not statistically significant. Survival rates of two groups in the 1st and 2nd year were no significant difference. In the 3rd year, the survival rate of PD group was significantly lower than HD group. The survival rate of HD group was insignificantly higher than the PD group in 4th and 5th years. Conclusion Patients＇ death causes with end-stage diabetic nephropathy in two groups were mainly infection and cardiovascular complications. It suggested that pre-venting infection and cardiovascular complications could improve ESDN patients＇ survival.