摘要
目的提供我国中等城市终末期肾病(ESRD)患者开始透析时肾功能水平的准确数据并分析相关因素,为选择合适的透析时机提供依据。方法查阅1998年1月至2004年8 月期间长沙市两大透析中心所有首次透析的终末期肾病住院患者的病案,其中514例数据齐全而人选并按不同条件分组。计算整组病例及各分组的平均Scr值、GFR预测值(eGFR)及其他统计指标,以及比较组间差异并与国外资料比较。结果 (1)男性较女性多;45岁以下患者占 50．4％;自费患者最多(55．4％),但比例逐年下降;医保患者占17．7％,而比例则逐年增高; 91．8％的患者选择血液透析为首次治疗方式;首位病因仍是肾小球肾炎(59．7％),其次为高血压肾病(10．9％)和糖尿病肾病(6．8%),肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。(2)平均Scr浓度为(1121．92±458．24)μmol／L;平均eGFR为 (4．98±2．24)ml·min-1·(1．73 m2)-1。(3)年轻人、无费用保障的患者、无业或农民、在职人员、学生、选择血液透析的患者、原发病为非糖尿病的患者中,Scr值较高而eGFR值则较低,组间差异均有统计学意义(P<0．01)。男性患者的Scr和eGFR值均高于女性(P<0．01,P<0．05)。(4) 低白蛋白血症患者占总例数的53．1％。当eGFR<8．4 ml·min-1·(1．73 m2)-1时,eGFR与血清白蛋白(Salb)呈正线性相关(r=0．093,P<0．05)。(3)与美国1999年资料比较,本组514例患者的eGFR预测值低于美国患者(P<0．01)。结论本组以年轻男性患者多见。肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。相当多的患者在肾功能非常差时才开始透析。患者普遍存在低白蛋白血症,eGFR下降到一定水平以后,Salb随eGFR下降而下降。本组514例ESRD患者开始透析的时机要较美国患者晚。
Objective To present the accurate level of renal function of 514 ESRD patients at the initiation of dialysis and analyze the correlative factors to provide evidence for the selection of the possible better time of dialysis start. Methods Levels of serum creatinine （Scr）, blood urea nitrogen （BUN） and serum albumin （Salb） together with other demographic and laboratory data were obtained through reviewing the case records of 514 ESRD in-patients initiated their first dialysis treatment from January 1998 to August 2004 in two large dialysis centers in Changsha. The patients were divided into different groups by various conditions. Mean Scr, evaluation GFR （eGFR） and other variables of the whole patient population and subgroups were measured and calculated. Then the differences were compared among groups and with foreign patient population. Results （1） Patients were relatively young, male more than female. Percentage of patients with medical insurance increased. 91.8% patients chose hemodialysis as the in＇st treatment. Glomerulonephritis was the maincause of ESRD but its percentage decreased meanwhile the percentage of hypertension and diabetes increased. （2）Tbe levels of Scr and eGFR were （1121.92±458.24）μmol/L and （4.98±2.24） ml·min^-1（1.73m^2）^-1. （3） In subgroups of younger, uninsured, unemployed, farmer, incumbent, students, selecting hemodialysis and non-diabetes, the mean Scr was significantly higher and mean eGFR was significantly lower as compared to corresponding groups （P 〈 0.01 ）. The mean Scr and eGFR were significantly higher in male than those in female patients （P 〈 0.01 and P 〈 0.05, respectively）. （4） 53.1% had hypoalbuminemia. When eGFR 〈 8.4 ml·min^-1·（1.73m^2）^-1, Salb was significantly correlated with eGFR （r = 0.093,P = 0.044）. （5） Compared to the data of the United States 1999, the eGFR of these 514 patients at the beginning of dialysis was significantly lower than that of US patients （P 〈 0.01 ）. Conclusions These 514 ESRD patients in Changsha possess certain demographic and clinical characteristics. Wide variation exists in renal function at the initiation of dialysis. Most patients start dialysis at very low levels of eGFR. Salb is positively correlated with eGFR only under certain conditions. The eGFR of ESRD patients at the beginning of dialysis is significantly lower than that of US patients.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2006年第3期153-157,共5页
Chinese Journal of Nephrology
关键词
肾透析
肌酸酐
肾小球滤过率
白蛋白
Renal dialysis
Creatinine
Glomerular filtration rate
Albumin
