20年间腹膜透析213例临床分析

Clinical analyses of 213 cases peritoneal dialysis in 20 years

关键词:  腹膜透析  年龄  糖尿病  死亡率

Key words:  peritoneal dialysis  age  diabetes  mortality

摘要:

［目的］ 分析20年来213例不卧床持续性腹膜透析（CAPD）患者的状况。［方法］ 横断面调查1988年12月~2008年12月期间213例CAPD≥3个月患者的状况。分组：①透析时间：前10年组（1988年12月~1998年12月）和近10年组（1998年12月~2008年12月）；②开始透析年龄：≥65岁组和<65岁组；③病因：糖尿病组和非糖尿病组。［结果］ ①近10年组年龄明显大于前10年组（61.8±16.0岁和 49.4±17.7岁，P<0.001），血肌酐水平明显低于前10年组（701.2±325.8 μmol/L和914.0±315.6 μmol/L，P<0.001），血红蛋白水平明显高于前10年组（84.7±18.8 g/L和 63.4±17.9 g/L，P<0.001）。②近10年组糖尿病比例较前10年组明显增高［59/125例（47.2%）和17/88例（19.3%），P<0.005］，而慢性肾炎比例明显降低［19/125例（15.2%）和49/88例（55.7%），P<0.01］。≥65岁组较<65岁组糖尿病和高血压肾硬化症比例明显增高［44/83例（53.0%）和32/130例（24.6%），P<0.005，19/83例（22.9%）和6/130例（4.6%），P<0.005］，而慢性肾炎的比例明显降低［5/83例（6.0%）和63/130例（48.4%），P<0.005］。③近10年组较前10年组死亡率明显降低［53/125例（42.4%）和50/88例（56.8%），P<0.05］。糖尿病组较非糖尿病组死亡率明显增加［44/75例（58.7%）和59/138例（42.8%），P<0.05］。④近10年组腹膜炎的死亡率较前10年组明显降低［13/50例（26.0%）和 5/53例（9.4%），P<0.05］。前10年组主要死因排序为：腹膜炎>脑出血>心衰/全身衰竭；近10年组则为心衰/全身衰竭>心梗>其他感染。≥65岁组心梗的死亡率较<65岁组明显增高［7/46例（15.2%）和2/57例（3.5%），P<0.05］。糖尿病组心梗的死亡率较非糖尿病组明显增高［7/44例（15.9%）和2/59例（3.4%），P<0.05］。［结论］ 老年及糖尿病患者是防治工作的重点，而心血管病和感染仍然是影响CAPD患者应预后的主要因素。

Abstract:

［Objective］ To analyze the status of 213 patients with continuous ambulatory peritoneal dialysis (CAPD) in 20 years. ［Method］ Two hundred and thirteen patients with CAPD were investigated in period from December 1988 to December 2008. They were divided into groups ① The time of the started dialysis: the group of the first 10 year (from December 1988 to December 1998) and second 10 year (from December 1998 to December 2008); ② The age of the started dialysis: the group of 65-years or older and the group of less than 65-years; ③ The cause of the disease: diabetic group and non-diabetic group. ［Results］ ① As compared with the group of the first 10 year, the mean age of the patients in the group of second 10 year was greater (61.8±16.0 years vs 49.4±17.7 years, P<0.001), and the mean level of serum creatinine was lower (701.2±325.8 μmol/L vs 914.0±315.6 μmol/L, P<0.001), and the mean level of hemoglobin was higher (84.7±18.8 vs 63.4±17.9 g/L, P<0.001). ② The proportion of the diabetes in the group of second 10 year was more increased than that of the group of first 10 year［59/125 (47.2%) vs 17/88 (19.3%), P<0.005］, but the proportion of the chronic nephritis was reduced ［19/125 (15.2%) vs 49/88(55.7%), P<0.01］. As compared with the group of less than 65-years, the proportion of diabetes and hypertension nephrosclerosis in the group of 65 years or older were increased ［44/83 (53.0%) vs 32/130 (24.6%), P<0.005, and 19/83 (22.9%) vs 6/130 (4.6%), P<0.005］, but the proportion of the chronic nephritis was reduced ［5/83 (6.0%) vs 63/130 (48.4%), P<0.005］. ③ The mortality of the group of second 10 year was more reduced than that of the first 10 year ［53/125 (42.4%) vs 50/88 (56.8%), P<0.05］. The mortality of the diabetic group was more increased than that of the non-diabetic group ［44/75 (58.7%) vs 59/138(42.8%) , P<0.05］. ④ The mortality of peritonitis in the group of second 10 year was more reduced than that of first 10 year ［13/50 (26.0%) vs 5/53(9.4%), P<0.05］. Major causes of death in the group of the first 10 year were peritonitis, cerebral hemorrhage, heart failure and systemic failure, while those in the group of the second 10 year were heart failure, systemic failure, myocardial infarction and infection. The mortality of the cardiovascular diseases in the group of 65-years or older was more notable increased than that in the group of less than 65-years ［7/46(15.2%)vs 2/57 (3.5%), P<0.05］. The mortality of the cardiovascular diseases in the diabetic group was more increased than that of the non-diabetic group ［7/44 (15.9%) vs 2/59 (3.4%), P<0.05］. ［Conclusion］ The cardiovascular disease and infection still are major affective factors in the prognosis of the patients with CAPD.