中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (12): 701-704.doi: 10.3969/j.issn.1671-4091.2016.12.013

• 中心管理与技术 • 上一篇    

湘潭地区终末期肾病维持性血液透析患者现况调查

成建钊1,余美春1,郭自炎1,陈跃俊2,李迅2,李鸿志3,张爱民4,齐中意5,甄上照6   

  1. 411100 湘潭，1湖南省湘潭市中心医院肾内科
    411100 湘潭，2湖南省湘潭市卫生局
    411100 湘潭，3湖南省湘潭市第一人民医院血液透析室
    411100 湘潭，4湖南省湘潭市第二人民医院血液透析室
    411100 湘潭，5湖南省湘潭县人民医院血液透析室
    411100 湘潭，6湖南省湘乡市人民医院血液透析室
  • 收稿日期:2016-06-28 修回日期:2016-08-27 出版日期:2016-12-12 发布日期:2016-12-05
  • 通讯作者: 余美春 yumeichun@163.com E-mail:yumeichun@163.com

A survey of end- stage renal disease patients with maintenance hemodialysis in Xiangtan district

  • Received:2016-06-28 Revised:2016-08-27 Online:2016-12-12 Published:2016-12-05

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摘要： 目的了解湘潭市终末期肾脏病(end stage renal disease,ESRD)维持性血液透析(maintenance hemodialysis，MHD)患者的病因构成、年龄分布、并发症控制、血液传播性疾病阳性率和医疗负担现状。方法收集2014 年11～12 月湘潭市所有血液透析中心维持性血液透析病例1166 例，采用问卷调查、查阅病历及实验室检查等方法，采集病例信息(包括患者基本信息、原发病诊断、并发症及合并症、血液透析治疗信息、药物治疗信息、透析前血压、血红蛋白(hemoglobin，Hb)、血磷、血钙、血清全段甲状旁腺激素、血液传播性疾病、医疗费用和医疗保险模式等信息)并进行分布特征描述。结果1166 例维持性血液透析患者中，男女之比为1.3:1，平均年龄(54.4±13.2)岁，透析龄范围3 个月～20 年，透析龄中位数2.0 年；前5 位原发病分别为慢性肾小球肾炎487 例(41.8%)，糖尿病肾病279 例(23.9%)，高血压肾损害260 例(22.3%)，梗阻性肾病51 例(4.4%)，多囊肾33 例(2.8%)，近2 年的新发病例中糖尿病肾病比例29.7%；患者每周平均透析治疗时间6～10h 者占54.2%，≥10h 者占38.2%；并发症治疗达标情况：高血压达标率35.8%；血红蛋白达标率41.4%；血磷达标率30.1%，血钙达标率58.3%，全段甲状旁腺激素达标率46.8%。透析患者死亡原因主要为心血管事件(42.4%)、感染(21.6%)、脑血管事件(12.9%)。患者月均医疗费用为(4746.1±1094.1)元；患者医疗保险模式以农合医疗(48.2%)以及职工医保(40.6%)为主，全自费仅仅占1.3%；血液传播性疾病阳性率：乙型肝炎6.69%，丙型肝炎3.52%，梅毒1.03%；所有被调查患者中血液透析后丙型肝炎转阳2 例，乙型肝炎及梅毒均为0 例。结论湘潭地区维持性血液透析患者中原发疾病以慢性肾小球肾炎为主，其次为糖尿病肾病和高血压肾病；首次透析年龄集中在36～59 岁年龄段，每周透析治疗时间6～10h/w 为主，高血压、肾性贫血、高磷血症、继发性甲状旁腺亢进等并发症达标率较低，治疗依从性及规范性仍需有待加强；血液透析后血液传播性疾病转阳率低，感染控制措施到位。

关键词: 维持性血液透析, 终末期肾病, 肾小球肾炎, 糖尿病肾病

Abstract: Objective To investigate etiology, age distribution, complication management, blood- borne diseases, and medical burden of end- stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) in Xiangtan district. Methods A total of 1,166 patients were recruited in the period of Nov. to Dec. 2014 from 9 dialysis centers in Xiangtan district. Questionnaire information, medical records, laboratory tests, case information (including basic patient information, primary renal disease, complications, comorbidities, hemodialysis modalities, medication, pre- dialysis blood pressure, hemoglobin, phosphorus, calcium, serum intact
parathyroid hormone, blood-borne diseases, medical expenses, medical insurance,etc) were collected, and then a descriptive study was performed. Results In the 1,166 MHD patients, the male to female ratio was 1.3:1, the average age was 54.4 ± 13.2 years, and the median dialysis age was 2.0 years (3 months-20 years). The top 5 primary diseases were chronic glomerulonephritis (n=487, 41.8% ), diabetic nephropathy (n=279, 23.9%), hypertensive nephropathy (n=260, 22.3%), obstructive nephropathy (n=51, 4.4%), and polycystic kidney disease (n=33,2.8%). The proportion of newly diagnosed diabetic nephropathy in the recent 2 years was 29.7%. Patients spent 6-10 hours/week for dialysis in 54.2% patients and ≥10 hours/week in 38.2% patients. The required levels achieved in 35.8% patients for blood pressure, 41.4% patients for hemoglobin, 30.1% patients for serum phosphorus, 58.3% patients for serum calcium, and 46.8% patients for intact parathyroid hormone (iPTH). The main cause for death in MHD patients was cardiovascular events (42.4%), followed by infections (21.6%), and cerebrovascular events (12.9%). The average medical expense was 4,746.1±1,094.1 yuan/ month. Medical expenses could be covered by rural cooperative medical insurance (48.2%) or medical insurance for employees (40.6%), and only 1.3% patients needed to pay the expenses by themselves. Hepatitis B
infection was found in 6.69% patients, hepatitis C in 3.52% patients, and syphilis in 1.03% patients. After hemodialysis, two patients turned to be hepatitis C positive, but none became hepatitis B or syphilis positive. Conclusion The main primary disease for MHD in Xiangtan district was chronic glomerulonephritis, followed by diabetic nephropathy and hypertensive nephropathy. Dialysis began at 36-59 years of age, and the dialysis time was 6-10 hours/week. The ratio of patients achieved the required levels for blood pressure, hemoglobin, phosphorous, calcium and iPTH were still low. Patient compliance and standardization of dialysis need to be improved further. The rate of blood-borne diseases caused by hemodialysis was low, indicating the effectiveness of infection control in dialysis.

Key words: Maintenance hemodialysis, End stage renal disease, glomerulonephritis, diabetic nephropathy