【摘要】 目的探讨选择不同透析模式的糖尿病终末期肾脏病(ESRD)患者的死亡风险差异。方法收集104例糖尿病终末期肾脏病患者。根据选择的透析方式,分为血液透析组和腹膜透析组。主要终点事件是死亡。采用Kaplan-Meier法分析患者的生存率,采用Cox回归分析2组患者发生死亡的危险因素。结果共有104例糖尿病ESRD患者纳入本研究,其中血液透析组42例,腹膜透析组62例。腹膜透析组的1、3、5年生存率分别为87%、77%、57%,高于血液透析组。糖尿病腹膜透析组的全因死亡发生率明显高于血液透析组患者(P<0.05)。多因素Cox回归发现,与血液透析组相比,腹膜透析组更具有生存优势(HR=0.84,95%CI:0.61~0.95,P<0.05)。糖尿病患者年龄>65岁(HR=1.58,95%CI:1.19~2.75,P<0.05)、同时存在多种并发症(HR=2.05,95%CI:1.95~2.23,P<0.05)、GHb A1c≥7%(HR=1.81,95%CI:1.09~2.29,P<0.05),选择腹膜透析模式较血液透析模式透析有更高的死亡风险。结论糖尿病腹膜透析患者总体生存率高于血液透析患者。然而,糖尿病老龄患者、存在多种并发症,或者血糖控制较差,选择腹膜透析模式具有更高的死亡风险。更多还原

【Abstract】 Objective To compare the difference in the mortality risk among diabetic patients with end-stage kidney disease( ESRD) receiving different dialysis modalities. Methods In total,104 diabetic patients with ESRD were recruited and divided into the hemodialysis( HD) and peritoneal dialysis( PD) groups.The primary endpoint was death. Survival was calculated using Kaplan-Meier method and the risk factors related to death were assessed by Cox regression analysis between two groups. Results A total of 104 diabetic patients with ESRD were enrolled in this study,included 42 patients treated by HD and 62 patients treated by PD. The 1-,3- and 5-year survival in the PD group were 87%,82%,and 68%,significantly higher compared with those in the HD group. The all-cause mortality in the PD group was significantly higher than that in the HD group( P < 0. 05). Multivariate cox regression analysis revealed that patients in the PD group presented with better survival compared with their counterparts in the HD group( HR = 0. 84,95% CI: 0. 61 ~ 0. 95,P< 0. 05). Elderly diabetic patients aged > 65 years( HR = 1. 58,95% CI: 1. 19 ~ 2. 75,P < 0. 05),with multiple complications( HR = 2. 05,95% CI: 1. 95 ~ 2. 23,P = 0. 04) or GHb A1c≥7%( HR = 1. 81,95%CI: 1. 09 ~ 2. 29,P < 0. 05) receiving PH had a higher mortality risk compared with those undergoing HD.Conclusion The overall survival of diabetic patients in the PD group was higher compared with that in the HD group. However,diabetic patients aged > 65 years,with multiple complications or poor control of blood glucose undergoing PD had a higher mortality risk than their counterparts receiving HD.更多还原