维持性透析患者恶性肿瘤的发生情况与相关因素探讨

目的探讨维持性透析患者的恶性肿瘤发生情况、相关因素、临床特点及预后。方法选择2007年1月～2007年12月期间北京大学人民医院肾内科维持性血液透析和腹膜透析的患者共166例,进行横断面研究。调查其恶性肿瘤的发生情况及临床特点,并行Logistic回归分析影响肿瘤发生的危险因素。结果166例维持性透析患者中11例发生恶性肿瘤,占透析患者的6.62%。Logistic回归分析结果显示年龄和血红蛋白（Hb）是肿瘤发生的独立危险因素。临床特点：11例患者中36%的患者出现不明原因的消瘦,82%的患者表现为不易纠正的贫血;泌尿系肿瘤患者均表现为间断无痛性肉眼血尿。早期诊断的5例患者均接受手术（包括肿瘤根治术、姑息手术）和（或）化疗,至今生存时间4～29月,平均14月;而其余6例未能早期诊断的肿瘤患者,确诊时间为3～6月,均未治疗。已有2例死亡。结论慢性维持性透析患者恶性肿瘤的发病率明显高于正常人群,年龄和Hb水平是恶性肿瘤发生的独立危险因素。早期诊断治疗有助于改善预后。

The occurrence of malignancies and its related factors in patients with maintenance dialysis

Objective To evaluate the incidence of malignancies and its related factors, clinical features and prognosis in patients on maintenance dialysis. Methods We recruited 166 maintenance hemodialysis or peritoneal dialysis patients into a cross-sectional study, to investigate the incidence of malignant tumors and the clinical features of the malignancies. We also used logistic regression analysis method to disclose the tumor-related factors. Results Among the 166 maintenance dialysis patients, 11 cases （6.62%） developed malignant tumors. Logistic regression analysis showed that age and hemoglobin level were the independent risk factors relateing to tumors. In the 11 patients, 36% of the patients had unexplained weight loss, and 82% exhibited refractory anemia. All of the patients with urinary tumors presented intermittent and painless gross hematuria. Early diagnosis was achieved in 5 patients, who could be treated with surgery （radical or palliative operation） and/or chemotherapy and whose survival time has been lasted for 4 to 29 months （average 14 months）. The malignancies of the remaining 6 patients were diagnosed at late stage （3 to 6 months later）, so that no specific therapy could be used and two of them died. Conclusion The incidence of malignant tumor was significantly higher in maintenance dialysis patients than in the general population. Age and hemoglobin level were two independent risk factors relating to malignant tumors. Early diagnosis and treatment are essential to improve their prognosis.