中国血液净化

›› 2010, Vol. 9 ›› Issue (12): 664-668.doi: 10.3969/j.issn.1671-4091.2010..00

• 临床研究 • 上一篇    下一篇

西藏藏族尿毒症患者的透析时机调查及与内地患者的比较分析

棋 梅 甘良英 陈 秀 蒲永梅 次 央 罗 萍 屈敬峰 德 吉 央 金   

  1. 西藏自治区第二人民医院内一科
  • 收稿日期:2010-07-05 修回日期:1900-01-01 出版日期:2010-12-12 发布日期:2010-12-12
  • 通讯作者: 棋梅

Survey of the disease period at which dialysis began in 116 uremia patients in Tibet region and comparison to those in the east part of China

QI Mei, GAN Liang-ying, CHEN Xiu, PU Yong-mei, CI Yang, LUO Ping, QU Jing-feng, DE Ji, YANG Jin   

  1. 1Department of Nephrology, Tibet Autonomous Region Second People’s Hospital, Lhasa 850002, China; 2Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2010-07-05 Revised:1900-01-01 Online:2010-12-12 Published:2010-12-12

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摘要： 目的 了解西藏地区藏族慢性肾衰竭(chronic renal failure,CRF)患者开始血液透析的时机及与内地(长沙市)患者透析时机的差异。方法 以1997年8月至2008年12月西藏自治区第二人民医院血液透析中心治疗的116例CRF患者为研究对象，根据患者开始透析时间分为A组和B组(A组：1997年8月1日至2005年12月30日，B组：2006年1月1日至2008年12月30日)，评价开始透析时肾功能[以估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)表示]、尿毒症症状、并发症以及首次透析的情况,了解西藏地区CRF患者的透析时机，比较西藏与内地CRF患者透析时机的差别，分析影响透析时机的因素。结果 西藏地区肾脏病患者进入透析时eGFR为(2.75±1.4)ml/(min•1.73m2)，其中 95.6%(110/116)为过晚透析。A组与B组患者尿毒症症状、并发症、自动出院、死亡、移植情况无明显差异，继续透析B组高于A组(P＜0.001)。与内地透析患者比较：原发病方面西藏地区肾小球肾炎所占比例低于内地，分别为38.7%和59.7%，差异有统计学意义(P＜0.01)，继发肾脏疾病高于内地，分别为35.4%和22.6%，差异有统计学意义(P＜0.001)。西藏地区首次透析eGFR水平明显低于内地(P＜0.001)。结论 西藏地区CRF患者近10年多数透析时机过晚，差于以长沙为代表的内地地区。过晚透析导致高并发症发生率及不良预后。

关键词: 西藏, 慢性肾衰竭, 血液透析, 透析时机

Abstract: Objective To investigate the time of beginning dialysis and the influence factors on hemodialysis in chronic renal failure (CRF) patients in Tibet region. Methods A total of 116 CRF patients treated in hemodialysis center of the Second People’s Hospital of Tibet Autonomous Region from August, 1997 to December, 2008 were surveyed. The patients were divided into group A (from August 1, 1997 to December 30, 2005), and group B (from January 1, 2006 to December 30, 2008). Renal function at the beginning of dialysis represented by estimated GFR (eGFR), symptoms of uremia, complications, and the patients’ status at the first dialysis were analyzed to understand the disease period when dialysis began and the influence factors on the period in CRF patients in Tibet region. Result (a) In patients in Tibet region, the eGFR was 2.75±1.4ml/min/1.73m2 in CRF patients at the beginning of dialysis, of whom 95.6% were at the very late stage of the disease. (b) There were no significant differences in uremia symptoms, and number of complications, discharge from hospital only by patients’ decision, death and transplantation between the two groups, but the number of persistence in dialysis was higher in group B than in group A (P＜0.001). (c) Compared the patients on dialysis in Tibet region with those in the east part of China, glomerulonephritis as the primary disease was lower in Tibet region (38.7% vs. 59.7%, P＜0.01), secondary renal diseases leading to dialysis were higher in Tibet region (35.4% vs. 22.6%, P＜0.001), and eGFR level at the first dialysis was significantly lower in Tibet region (P＜0.001). Conclusion In the recent 10 years, the disease period at which dialysis began was still too late in most CRF patients in Tibet region. The influence factors on the delayed treatment included health education, disease screening and healthcare.

Key words: Chronic renal failure, Hemodialysis, Timing of dialysis