维持性血液透析25年回顾分析--解放军肾脏病研究所的经验

目的回顾性分析维持性血液透析(CHD)患者的人口统计学和流行病学特点。方法从1974年1月至1999年4月，在南京军区南京总医院肾脏病研究所血液净化中心接受CHD治疗的患者2004例，分析了患者的性别、年龄、原发病因、治疗持续时间和转归，及1995年以后CHD患者的死亡原因。结果2004例尿毒症患者中以中、青年为主，平均年龄41.7±13.5岁，男／女为2.21，其中38.5％患者原发病因不明，已知病因者以原发性肾小球肾炎为主，占66.1％，经肾活检明确诊断者以IgA肾病最多见；继发性肾小球疾病占17.1％，其中狼疮性肾炎占首位，糖尿病和高血压病居其次，分别占6.1％、4.9％和2.1％；777例CHD患者在本中心治疗时间超过3个月，其中18.4％仍在我院HD治疗，最长者已存活16年；31.9％患者行肾移植，30.4％转至外院治疗，3.90％改为腹膜透析，13.9％患者死亡；近年来患者的主要死因为脑血管意外(36.7％)和急性左心衰(20.0％)。CHD患者1年生存率93.2％，5年生存率64.2％，10年生存率55.1％。结论①本组患者以中、青年为主，男性多见；②IgA肾病是导致尿毒症的主要已知病因；③CHD患者1年、5年和10年生存率分别为93.2％、64.2％和55.1％，主要死亡原因为脑血管意外和心衰。

ANALYSIS OF 25 YEARS' MAINTENANCE HEMODIALYSIS PRACTICE IN BLOOD PURIFICATION CENTER OFJINLING HOSPITAL FOR 25 YEARS

OBJECTIVE To analyze the demographic and epidemiologic data of hemodialyze patients during the last 25 years in theBlood Purification Center of Research Institute of Nephrology, Jinling Hospital. METHODOLOGY This is a retrospectiveanalysis which included 2004 maintained hemodialysis patients treated between January 1974 and April 1999. Data on the demo-graphic and epidemiologic aspects of these patients were examined, life expectancy and gross mortality rate were calculated. RESULTS In this group of patients, the average age at start of hemodialysis was 41.7±13.5, with 71.1% between the age of 20and 50. In the analysis of the diseases causing ESRD, primary glomerulonephritis accounted for 66.1%, secondary glomerular dis-ease for 17.1%, chronic tubulo-interstitial nephritis for 9.7 %, hereditary-congenital disease for 4.6% and other causes for 2.4 %.In primary glomerulonephritis, IgA Nephropathy was the most common type. And in secondary glomerulonephritis, lupus nephritis,diabetic nephropathy and hypertensive nephrosclerosis were the top three common types. In the maintenance hemodialysis patientswith long term follow-up in the center ( n = 777) ,31.9% of them received renal transplantation,30.4% transferred to other hospi-tals for hemodialysis, and 13.9% died. The most frequent causes of death in maintenance hemodialysis patients were cerebral vas-cular disease and heart failure in recent years. The 1-year, 5-year and 10-year survival rate of chronic hemodialysis patients was93.2% ,64.2% and 55.1% respectively,and the gross mortality rate(GMR)of 1-and 5-year was 10.2% and 4.1%. CON-CLUSION In this center, most of the patients at start of hemodialysis were in the age of 20～50, with priinary glomerular diseaseas the most common cause for ESRD. In maintenance hemodialysis patients, the survival rates of 1-year,5-year and 10-year were93.2%, 64.2% and 55.1% respectively. The most frequent causes of death in this group of patients were cerebral and heart vas-cular diseases.