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目的:探讨合并心血管疾病(CVD)的终末期肾病患者不同透析方式的死亡风险差异。方法:选取2009年5月至2014年5月来自广州军区广州总医院及广州市第一人民医院共591例透析患者。采集基线人口统计学资料、合并症及实验室指标等,采用Cox比例风险模型分析不同透析方式的患者的死亡风险差异。结果:共纳入终末期肾病患者591例,其中腹膜透析(PD)组有285例,血液透析(HD)组有306例。合并CVD的患者有123例,无CVD的患者468例。血液透析患者的平均年龄为(57.83±16.15)岁,腹透患者的平均年龄为(46.67±14.85)岁。多因素研究分析,心血管疾病(HR=3.270,95%CI:1.573~6.798,P=0.002)、脑卒中(HR=2.479,95%CI:1.034~5.945,P=0.042)、Kt/V(HR=2.433,95%CI:1.610~3.676,P<0.001)是血液透析组的死亡危险因素。年龄(HR=1.063,95%CI:1.032~1.096,P<0.001)、脑卒中(HR=3.980,95%CI:1.781~8.891,P=0.001)及低血红蛋白(HR=0.966,95%CI:0.945~0.987,P=0.002)是腹膜透析组的死亡危险因素。无论选择何种透析方式,合并CVD的透析患者的死亡率均高于无CVD的透析患者。而无论有无合并CVD,PD组的生存率均高于HD组。差异具有统计学意义。结论:合并CVD的透析患者死亡率高于无CVD的透析患者。合并CVD的患者选择腹膜透析较血液透析具有更高的生存率。
Objective: To investigate the differences in the risk of death among different dialysis modalities in end-stage renal disease with cardiovascular disease (CVD). Methods: A total of 591 dialysis patients from Guangzhou General Hospital of Guangzhou Military Region and Guangzhou First People’s Hospital from May 2009 to May 2014 were selected. Baseline demographic data, comorbidities and laboratory parameters were collected and Cox proportional hazards models were used to analyze the differences in risk of death among patients on different dialysis modalities. RESULTS: A total of 591 patients with end-stage renal disease were enrolled, of whom 285 were peritoneal dialysis (PD) and 306 were hemodialysis (HD). There were 123 patients with CVD and 468 patients without CVD. The average age of hemodialysis patients was (57.83 ± 16.15) years, and the mean age of peritoneal dialysis patients was (46.67 ± 14.85) years. Multivariate analysis showed that cardiovascular disease (HR = 3.270,95% CI 1.573 ~ 6.798, P = 0.002), stroke (HR 2.479,95% CI 1.034-5.945, P = 0.042) HR = 2.433, 95% CI: 1.610-3.676, P <0.001) were risk factors for death in the hemodialysis group. (HR = 1.080, 95% CI: 1.781-8.891, P = 0.001) and low hemoglobin (HR = 0.966, 95% CI: 0.945 ~ 0.987, P = 0.002) were the risk factors of death in peritoneal dialysis group. Regardless of the type of dialysis method selected, the mortality of dialysis patients with CVD was higher than that of non-CVD dialysis patients. The survival rate of PD group was higher than that of HD group with or without CVD. The difference was statistically significant. Conclusions: Mortality in dialysis patients with concurrent CVD is higher than in those without CVD. Peritoneal dialysis in patients with concurrent CVD has a higher survival rate than hemodialysis.