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目的:探讨维持性透析患者脑卒中的发病率及危险因素。方法:选取2008年1月至2012年12月在广州军区广州总医院及广州市第一人民医院共590例透析患者,分为血液透析组和腹膜透析组;主要终点事件是脑卒中。通过Cox回归模型探讨透析患者发生脑卒中的独立危险因素;两组间的病死率比较采用Ka-plan-Meier曲线分析。结果:590例透析患者的平均随访时间为32.5个月。其中血液透析组有285例,腹膜透析组305例;总人群的脑卒中发病率为49.2/1 000人年,血透组的脑卒中发病率为74.0/1 000人年,腹透组的脑卒中发病率为31.8/1 000人年。相对于腹膜透析组,血透组累积脑卒中发病率明显更高(HR=2.43;P<0.001);多因素分析发现,年龄(HR=1.05;95%CI:1.02~1.09;P=0.003)、糖尿病(HR=1.98;95%CI:1.31~3.46;P=0.001)、心血管疾病(HR=2.06;95%CI:1.62~3.05;P<0.001)、高甘油三酯(HR=1.20;95%CI:1.08~1.58;P=0.034)及血液透析(HR=2.03;95%CI:1.46~3.89;P=0.005)是透析患者发生脑卒中的独立危险因素。结论:年龄、糖尿病、心血管疾病、高甘油三酯及血液透析是透析患者发生脑卒中的独立危险因素,对于透析患者应积极控制以上相关危险因素,从而降低透析患者的脑卒中发病率。
Objective: To investigate the incidence and risk factors of stroke in maintenance hemodialysis patients. Methods: A total of 590 dialysis patients in Guangzhou General Hospital of Guangzhou Military Region and Guangzhou First People’s Hospital from January 2008 to December 2012 were divided into hemodialysis group and peritoneal dialysis group. The main end point was stroke. Cox regression model was used to investigate the independent risk factors for stroke in dialysis patients. The mortality was compared by Ka-plan-Meier curve analysis. Results: The mean follow-up of 590 dialysis patients was 32.5 months. Of these, 285 were in the hemodialysis group and 305 in the peritoneal dialysis group; the overall incidence of stroke was 49.2 / 1,000 person-years, the incidence of stroke in the hemodialysis group was 74.0 / 1,000 person-years, The incidence of stroke was 31.8 per 1,000 person-years. Compared with the peritoneal dialysis group, the cumulative incidence of stroke in the hemodialysis group was significantly higher (HR = 2.43; P <0.001). Multivariate analysis showed that age (HR = 1.05; 95% CI: 1.02-1.09; , Diabetes (HR = 1.98; 95% CI: 1.31- 3.46; P = 0.001), cardiovascular disease (HR = 2.06; 95% CI: 1.62-3.05; 95% CI: 1.08-1.58; P = 0.034) and hemodialysis (HR = 2.03; 95% CI: 1.46-3.89; P = 0.005) were independent risk factors for stroke in dialysis patients. Conclusion: Age, diabetes mellitus, cardiovascular disease, hypertriglyceridemia and hemodialysis are independent risk factors of stroke in dialysis patients. Dialysis patients should actively control the above risk factors and thus reduce the incidence of stroke in dialysis patients.