發(fā)布時(shí)間：2018-01-07 02:12

  本文關(guān)鍵詞：腹膜透析患者早期殘腎功能快速下降的影響因素及對(duì)生存的影響分析　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 殘腎功能 死亡率 腹膜透析

【摘要】：目的:保護(hù)殘腎功能對(duì)透析病人具有非常重要的意義。既往文獻(xiàn)中腹膜透析患者殘腎功能的影響因素存在很大的爭(zhēng)議,本研究結(jié)合腹透患者隨訪情況探尋早期殘腎功能快速下降的影響因素及對(duì)患者生存的影響。方法:本研究為單中心回顧性研究,納入了 2005年1月1日到2015年6月30日在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院腎臟病中心行腹膜透析的911名尿毒癥患者。腹膜透析患者殘腎功能的下降速率用線性回歸方程的斜率表示。分析腹膜透析患者透析開始1年內(nèi)殘腎功能下降速率的影響因素以及與患者全因死亡的關(guān)系。結(jié)果:研究對(duì)象的平均年齡為49.4±13.9歲,55.5%的患者為男性,殘腎功能下降的中位速度為 0.308(0.190-0.475)mL/month/1.73 m2。79 名患者(8.7%)在隨訪期間死亡。多因素線性回歸分析顯示了男性,非糖尿病,高水平的透前殘腎功能,低尿酸,低血清白蛋白,高鈣和高甲狀旁腺素是腹膜透析患者透析開始1年內(nèi)殘腎功能下降的獨(dú)立危險(xiǎn)因素。多因素Cox比例風(fēng)險(xiǎn)回歸模型顯示與殘腎功能下降速度慢的患者相比,殘腎功能下降快的患者全因死亡率更高(Model 4;HR,2.97,95%CI,1.53 to 5.77,P = 0.001)。將殘腎功能的下降速度作為一個(gè)連續(xù)變量時(shí),1年內(nèi)殘腎功能每下降1 mL/month/1.73 m2與患者全因死亡的風(fēng)險(xiǎn)比為6.19(95%CI,2.97 to 12.9,P0.001)。但殘腎功能的下降與患者心血管死亡無明顯相關(guān)性(Model 4;HR,3.33,95%CI,0.84 to 13.1,P = 0.086)。結(jié)論:早期殘腎功能的快速下降是腹膜透析患者全因死亡的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to protect the residual renal function has very important significance in dialysis patients. Controversial factors in peritoneal dialysis patients with residual renal function in the previous literature, this study combined with peritoneal dialysis patients were factors influencing residual renal function in the early rapid decline and affected the survival of patients. Methods: the research is to study a review of single center, in January 1, 2005 to June 30, 2015 in 911 uremic patients of Zhejiang University Medical College First Affiliated Hospital for peritoneal dialysis. The slope of residual renal function in peritoneal dialysis patients with the decreasing rate of the linear regression equation. Analysis of peritoneal dialysis patients start dialysis residual renal function within 1 years of decline rate and influence factors patients with all-cause mortality. Results: the average age of the study participants was 49.4 + 13.9 years, 55.5% of the patients were male, residual renal function decline The median rate of 0.308 (0.190-0.475) mL/month/1.73 m2.79 (8.7%) patients died during the follow-up period. The multivariate linear regression analysis showed that male, non diabetes, high level through the residual renal function, low uric acid, low serum albumin, high calcium and high PTH is dialysis in patients with peritoneal dialysis start the independent risk factors of residual renal function decline in 1 years. The multivariate Cox proportional hazard regression model showed that compared with the loss of residual renal function in patients with slow speed, residual renal function decreased quickly with all-cause mortality higher (Model 4; HR, 2.97,95%CI 1.53, to 5.77, P = 0.001). The residual renal function the rate of decline as a continuous variable, the residual renal function within 1 years of each 1 mL/month/1.73 reduction with M2 risk of all-cause mortality ratio was 6.19 (95%CI 2.97, to 12.9, P0.001). But the decline of residual renal function in patients with cardiovascular death has no obvious correlation (Model 4 HR, 3.33,95%CI, 0.84 to 13.1, P = 0.086). Conclusion: the rapid decline in the function of the early remnant kidney is an independent risk factor for all causes of death in peritoneal dialysis patients.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5
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本文編號(hào)：1390529