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初始腹透转血透患者长期预后的分析（肾脏组稿）
Long-term prognosis of peritoneal dialysis patients switching to hemodialysis

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DOI:
作者:
陈雅，朱铭力，方炜，方燕，颜佳毅，林星辉，张伟明，黄佳颖，顾爱萍，章海芬，林其圣，倪
CHEN Ya, ZHU Ming-li, FANG Wei, FANG Yan, YAN Jiayi, LIN Xinghui, ZHANG Weiming, HUANG Jiaying, GU Aiping, ZHANG Haifen, LIN Qisheng, NI Zhaohui
作者单位:
上海市仁济医院肾脏科
Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University
关键词:
腹透；血透；预后
peritoneal dialysis, hemodialysis, prognosis
摘要:
目的：了解初始腹膜透析患者转血透的原因，观察此类患者的长期预后及分析其死亡原因。 方法：选取1990年1月1日至2010年12月31日期间在上海交通大学医学院附属仁济医院维持性血液透析患者，收集其人口学资料、原发病、预后、透析龄等指标，进一步分析其血透前情况（包括非透析治疗、腹膜透析、肾移植等），分析其中初始腹透患者转血透的原因及其预后和死亡原因。比较初始腹透转血透亚组和单纯血透亚组患者年龄、性别、原发病、死亡原因的差异。运用Kaplan-Meier曲线和log-Rank检验比较腹透转血透组患者和单纯血透组患者的存活率。 结果：1990年1月1日至2010年12月31日维持性血液透析患者共计536例，男性占61.7%，原发病中慢性肾炎占36.2%，糖尿病占11.3%，高血压占9.2%。开始血透前非透析治疗患者412例，由腹透转血透患者67例（12.5%），其中因腹膜炎转血透者占68.7%，解剖因素（胸膜漏等）所致者占14.9%，超滤衰竭占11.9%，其它原因占4.5%。与单纯血透组比较，初始腹透转血透组患者女性比例更高（59.7% vs 39.1%，p=0.002），开始透析年龄更轻（50.3±15.7岁 vs 55.2±17.6岁，p=0.034），透析龄更长（9.7±5.4 年vs 8.1±5.4年，p=0.022）。初始腹透转血透组患者1年存活率97%，5年存活率77.5%，10年存活率60.1%，略高于单纯血透组患者，但未达到统计学意义（log-Rank：p=0.559）。其死亡原因中排首位的是脑血管意外，占25.8%，其次为恶液质22.6%和感染19.2%，与单纯血透组患者相比无显著性差异。 结论：初始腹透患者转血透的主要原因为腹膜炎、胸膜漏及超滤衰竭。初始腹透转血透的患者长期预后并不劣于单纯血透患者。此结论的推广还需进一步大样本研究证实。
【Abstract】Objective To determine the causes of peritoneal dialysis patients switching to hemodialysis as well as their long-term prognosis and reasons of deaths. Methods Maintained hemodialysis patients in Renji Hospital affiliated to Shanghai Jiaotong University were enrolled in this study during a period from January, 1st, 1990 to December, 31st, 2010. Data of their demographic information, primary diseases, prognosis, dialysis period was collected. We analyzed the causes of a subgroup of peritoneal dialysis patients switching to hemodialysis, their prognosis and the reasons for their deaths. Further more, we compared age, sex, primary diseases and causes of deaths between a group of peritoneal dialysis patients switching to hemodialysis and a group of simple hemodialysis patients. Kaplan-Meier analysis and log-Rank test were used to compare survivals of the two groups. Results A total of 536 patients were analyzed, 61.7% were males. The top three primary diseases were chronic glomerular nephritis (36.2%), diabetes (11.3%) and hypertension (9.2%). There were 412 patients received non-dialysis treatments before hemodialysis and 67(12.5%) patients changed from peritoneal dialysis to hemodialysis. Peritonitis (68.7%) was the primary cause for their switch to hemodialysis, followed by anatomic factors (such as pleural leakage(14.9%) , ultrafiltration failure(11.9%) and others(11.3%). There were more females （59.7% vs 39.1%，p=0.002）, younger age at initial dialysis(50.3±15.7 vs 55.2±17.6y，p=0.034) and longer dialysis period（9.7±5.4 vs 8.1±5.4y，p=0.022） in peritoneal dialysis patients switching to hemodialysis, compared with simple hemodialysis patients. The 1st, 5th and 10th survival of the former group was 97%, 77.5% and 60.1%, respectively, which was a little higher than that of simple hemodialysis patients, while it didn’t reach statistical significance（log-Rank：p=0.559）. The primary cause of death was cerebrovascular accident (25.8%), followed by cachexia (22.6%) and infection (19.2%) in peritoneal dialysis patients switching to hemodialysis, but no significant difference was seen within the two groups. Conclusion Primary causes of peritoneal dialysis patients switching to hemodialysis were peritonitis, pleural leakage and ultrafiltration failure, respectively. Long-term prognosis of them was no worse than that of simple hemodialysis patients. More clinical evidence was needed from researches of large samples.

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