摘要目的 研究慢性肾脏病(CKD)5期高龄男性患者出血的相关危险因素及预后.方法 本研究为回顾性队列研究.选取2009年1月至2014年1月于解放军总医院老年肾脏病科住院治疗的143例高龄男性CKD 5期患者,根据是否发生出血事件分为出血组和非出血组,分析比较两组患者的病史及血液理化指标的差异,并对所有患者进行为期12个月的随访和预后分析.结果 143例患者中,67例发生出血,76例未发生出血.与非出血组比较,出血组患者的年龄较大[(89±4)比(87±5)岁,P=0.020],肺部感染发生率较高(32.84％比9.21％,P＜0.001),活化部分凝血活酶时间[(40.86±8.02)比(38.41 ±5.72)s,P=0.036]、纤维蛋白原[(4.09±0.75)比(3.62 ±0.67) g/L,P＜0.001]、血尿素氮(BUN)水平[(37.19±10.66)比(32.86±8.97) mmol/L,P=0.009]均较高,差异均有统计学意义(均P＜0.05).多因素logistic回归分析发现肺部感染(OR =0.286,P=0.014)、平均血小板体积小(OR=1.290,P=0.048)、纤维蛋白原(OR=0.444,P=0.004)、BUN(OR=0.959,P =0.034)、收缩压(OR=0.970,P=0.013)是发生出血的独立危险因素(P＜0.05).以3、6、12个月为观察点进行随访研究发现,出血组患者在3个月时发生全因死亡的比例明显高于非出血组,3、12个月时再发出血事件及12个月时再发主要出血事件的比例明显高于非出血组(均P＜0.05).结论 高龄男性CKD 5期患者容易发生出血并发症,且再发出血可能性较大.肺部感染、平均血小板体积小、纤维蛋白原、BUN、收缩压是发生出血的独立危险因素.

abstractsObjeetive To analyze the risk factors and prognosis of bleeding in very old male patients with stage 5 chronic kidney disease (CKD).Methods The clinical data of 143 very old male patients with stage 5 CKD was retrospectively analyzed.According to the occurrence of bleeding,the patients were divided into two groups including the hemorrhage group and the non-hemorrhage group.The history of diseases,renal function,blood cell parameters and coagulation index were compared and analyzed between the two groups.The prognosis of patients with a period of 12 months was studied.Results Among 143 patients,67 cases (46.85％) suffered bleeding,and the other 76 patients (53.15％) were without bleeding.The age [(89 ± 4) vs (87 ± 5) years,P =0.02],pulmonary infection (32.84％ vs 9.21％,P ＜ 0.001),activated partial thromboplastin time [(40.86 ± 8.02) vs (38.41 ± 5.72) s,P =0.036],fibrinogen [(4.09 ± 0.75) vs (3.62 ± 0.67) g/L,P ＜ 0.001],blood urea nitrogen (BUN) [(37.19 ± 10.66) vs (32.86 ± 8.97) mmol/L,P =0.009] were significantly increased in the hemorrhage group compared with the non-hemorrhage group.Multivariate logistic regression analysis showed that the incidence of pulmonary infection (OR =0.286,P =0.014),lower levels of mean platelet volume (OR =1.290,P =0.048),higher levels of fibrinogen (OR =0.444,P =0.004),BUN (OR =0.959,P =0.034) and systolic blood pressure (OR =0.970,P =0.013) were the independent risk factors of bleeding in the very old male patients with stage 5 CKD (P ＜ 0.05).All patients were followed up for 12 months.The proportion of all causes of death at the 3rd month,and bleeding events at the 3rd or 12th month,and recurrent major bleeding events at the 12th month were significantly higher in the hemorrhage group than those in the nonhemorrhage group.Conclusions Very old male patients with stage 5 CKD are prone to bleeding complications,and have more possibilities to bleed again.Pulmonary infection,average volume of blood platelet,fibrinogen,BUN,and systolic blood pressure were the independent risk factors of bleeding in these patients.