摘要
目的探讨慢性肾脏病(CKD)4期患者发生终点事件的危险因素。方法选择2014年5月1日—2016年4月30日间在安吉县中医院和安吉县人民医院住院或门诊诊断为CKD4期的患者共210例,对其进行随访,终点事件为肾脏替代治疗或全因死亡,随访终止时间为2017年4月30日。每3个月至少随访1次,记录性别、年龄,以及糖尿病肾病、高血脂、高尿酸、高血磷、低白蛋白血症、中重度贫血和血压控制不良的患者构成比。引入Cox比例风险回归模型进行分析,并对筛选出的危险因素行比例风险假定检验,采用Kaplan-Meier(K-M)法绘制生存曲线。结果发生终点事件83例(39.5%),其中肾脏替代治疗79例,死亡4例,均为心血管死亡;截至发生终点事件时该83例中有74例进展为CKD5期。未发生终点事件127例(60.5%),截至随访终止时进展为CKD5期44例。糖尿病肾病、高脂血症、高尿酸血症、高血磷、低白蛋白血症、中重度贫血、血压控制不良患者构成比分别为29.0%(61/210)、27.1%(57/210)、59.5%(125/210)、32.9%(69/210)、24.3%(51/210)、23.8%(50/210)、31.4%(66/210)。Cox比例风险回归模型分析结果显示,糖尿病肾病(OR=4.902,95%CI为3.048～7.884)、高尿酸血症(OR=3.306,95%CI为1.944～5.622)、高血磷(OR=2.801,95%CI为1.799～4.359)、中重度贫血(OR=1.755,95%CI为1.129～2.727)为CKD4期发生终点事件的危险因素(P值均<0.05)。采用K-M法绘制生存曲线,对Cox比例风险回归分析筛选出的危险因素进行比例风险假定检验,结果显示,糖尿病肾病、高尿酸血症、中重度贫血是CKD4期发生终点事件的危险因素,高血磷不是CKD4期发生终点事件的危险因素。结论 CKD4期发生终点事件的危险因素有糖尿病肾病、高尿酸和中重度贫血。
Objective To identify the risk factors related to the occurrence of endpoint events in patients with chronic kidney disease （CKD） stage 4. Methods A total of 210 patients with CKD stage 4 were admitted to Anji Hospital of Traditional Chinese Medicine and Anji People＇s Hospital from May 1, 2014 to April 30, 2016 and followed up in this prospective cohort study. The endpoint events were renal replacement therapy or all-cause death. The end of follow-up was April 30, 2017. The patients were followed up at least once every three months. Sex, age, the constitution ratios of patients with diabetic nephropathy, hyperlipoidemia, hyperuricemia, hyperphosphatemia, hypoalbuminemia, moderate-severe anemia, and poorly controlled blood pressure were recorded. Then these factors were analyzed by the Cox regression model, and the screened risk factors were tested by proportional hazard hypothesis test. Survival curves were plotted by Kaplan-Meier （K-M） method. Results During the follow up, endpoint events occurred in 83 patients （39. 5%）, including 79 with renal replacement therapy and 4 death caused by cardiovascular diseases. CKD stage 5 occurred in 74 patients with endpoint events and 44 patients without endpoint events at the end of follow up. The constituent ratios of patients with diabetic nephropathy, hyperlipoidemia, hyperuricemia, hyperphosphatemia, hypoalbuminemia, moderate-severe anemia, and poorly controlled blood pressure were 29.0% （61/210）, 27. 1% （57/210）, 59.5% （125/210）, 32.9% （69/210）, 24.3% （51/210）, 23.8% （50/210）, and 31.4% （66/210）, respectively. The result of Cox regression analysis showed that diabetic nephropathy （OR = 4. 902, 95% Cl= 3. 048 - 7. 884）, hyperuricemia （OR = 3. 306, 95% Cl： 1.944 - 5. 622）, hyperphosphatemia （OR = 2. 801, 95% Cl： 1. 799 - 4.359）, moderate-severe anemia （OR = 1. 755, 95% Cl： 1. 129 - 2. 727） were the risk factors of endpoint events. The result of the Kaplan-Meier curve showed that diabetic nephropathy, hyperuri
作者
季景
陈小平
寿张飞
刘剑飞
JI Jing;CHEN Xiaoping;SHOU Zhangfei;LIU Jianfei(Kidney Disease Center,The First Affiliated Hospital of Zhejiang University,Hangzhou 310003,Zhejiang,China;Corresponding author： E-mail：44011876 @qq.com)
出处
《上海医学》
CAS
北大核心
2018年第10期588-592,共5页
Shanghai Medical Journal
