不同等级医院血液透析患者原发病及死因的差异性分析

目的  回顾性分析不同等级医院血液透析（血透）患者原发病及死因的构成比。方法  从中国知网、万方、维普数据库搜集1986～2013年有关血透原发病及死因的文献，共搜集3 601例维持性血透患者，死亡2 432例，按文献数据来源，分为二甲医院、三乙医院、三甲医院，纳入的研究血透原发病的例数分别为871、723和1 523例；纳入研究血透死因的例数分别为312、429和1 207例，分析其原发病及死因构成比。结果  血透患者原发病为慢性肾小球肾炎占49.32%，糖尿病占18.24%，高血压占14.22%；不同时期不同等级医院血透患者原发病构成比比较，差异有统计学意义（P <0.05），其中糖尿病及高血压构成比呈上升趋势，尤以糖尿病为甚。血透患者主要死因为：心血管疾病（42.35%）、脑血管疾病（21.5%）、感染（11.76%）；2000年前二甲医院血透患者主要死因为脑血管疾病、心血管疾病、感染、高钾，2000年后相应为心血管疾病、脑血管疾病、感染、多器官功能障碍综合征（MODS），三级医院血透患者主要死因为心血管疾病、脑血管疾病、感染，且心血管疾病构成比呈上升趋势。二甲医院血透患者主要死因与三甲医院比较，差异有统计学意义，但三乙医院与三甲医院比较，差异无统计学意义。结论  血透患者主要原发病为慢性肾小球肾炎、糖尿病、高血压，其中糖尿病构成比呈上升趋势；同一时期三级医院血透患者中糖尿病、高血压构成比更高。血透患者主要死因为心血管疾病、脑血管疾病、感染，且心血管疾病构成比呈上升趋势。

Variance analysis about primary diseases and death of patients with hemodialysis in different grade hospitals

Objective To analyze the etiology and causes of death in end-stage renal diseases (ESRD) with hemodialysis (HD) in different grade of hospitals. Methods The retrospective analysis included 3,601 cases of patients with maintenance hemodialysis (MHD) and 2,432 cases of death from 1986 to 2013. Data on the etiology and mortality were calculated. According to the sources of data, the hospitals were divided into three groups (2A, 3B and 3A), the cases of primary diseases on hemodialysis were 871, 723 and 1,523 respectively; the cases of death on hemodialysis were 312, 429 and 1,207 respectively. The constituent ratios of primary diseases and causes of death were analyzed. Results As the leading cause, chronic glomerulonephritis accounted for 49.32%, followed by diabetic nephropathy (18.24%) and hypertensive nephropathy (14.22%). At different periods, the composition ratios of primary diseases were significantly different (P < 0.05) in different grade hospitals. In recent years, the constituent ratios of diabetic nephropathy and hypertensive nephropathy rose, especially diabetes nephropathy. The patients with HD mainly died of cardiovascular diseases (42.35%), cerebro-vascular diseases (21.5%) and infections (11.76%). In the 2A hospitals, the patients with HD mainly died of cerebrovascular diseases, cardiovascular diseases, infections and hyperkalemia before 2000; but after 2000, the main causes of death were cardiovascular diseases, cerebrovascular diseases, infections and multiple organ dysfunction syndrome (MODS). The patients with HD mainly died of cardiovascular diseases, cerebrovascular diseases, infections in the 3A hospitals, and cardiovascular diseases were more and more. There were significant differences in the main causes of death in the patients with HD between the 2A and 3A hospitals, but not between the 3A and 3B hospitals. Conclusions The main primary diseases of HD are chronic glomerulo-nephritis, diabetic nephropathy and hypertensive nephropathy; among which the constituent ratio of diabetic nephropathy is in a rising trend. During the same period, diabetic nephropathy and hypertensive nephropathy constitute higher ratios in 3A hospitals. The first cause of death is cardiovascular events, followed by cerebro-vascular disorders and infections, and the constituent ratio of cardiovascular events is rising.