巴尔干地方性肾病患者的血液透析治疗：一项流行病学研究。

Cukuranovic Rade, Jovanovic Ivan, Miljkovic Sladjana, Stefanovic Natalija, Vlajkovic Slobodan, Prokopovic Miomir, Stefanovic Vladisav

Faculty of Medicine, Nis, Serbia.

Ren Fail. 2007;29(7):805-10. doi: 10.1080/08860220701573475.

AIM

To analyze hemodialysis (HD) treatment of patients with Balkan endemic nephropathy (BEN) from five endemic villages in the South Morava Region of Serbia. Analyses of patterns of incidence may generate hypotheses about the underlying causes of BEN, and prevalence data provide information on the current and likely future burden on health services for managing BEN.

METHODS

A total of 143 end-stage kidney disease patients (ESKD) with BEN were admitted to the renal replacement program from 1974 to 2004: 121 to HD, 15 peritoneal dialysis, and 7 kidney transplantation. As a control group, 117 patients with other kidney disease (chronic pyelonephritis, glomerulonephritis, and ischemic nephropathy) admitted to HD at the time of BEN patients and matched by age and gender were studied.

RESULTS

Most of the BEN patients (93.4%) treated by HD were born from 1917 to 1941. The majority of patients (79.3%) started HD from 1977 to 1991 (period of 15 years). The mean age of BEN patients starting HD treatment was 49.1 years in the period from 1974 to 1978, and increased steadily in the following years, being 72.5 years in the last period of study (2004-2006) The mean survival time of BEN males was 4.70 (95% CI 3.66-5.75) and for females was 5.02 (95% CI 1.47-4.53). Difference between males and females was not statistically significant (log rank 0.14, p = 0.7, P > 0.5). Mean survival times of 4.84 (95% CI 3.97-5.70) in BEN patients and 3.1 (95% CI 2.78-3.84) in other kidney disease patients were found. Difference between BEN patients and controls was statistically significant (log rank 8.38, p = 0.0038, P < 0.01).

CONCLUSION

The population of endemic villages around the South Morava River admitted to HD treatment after 1974 was exposed to environmental toxicant(s) from 1917 to 1941. The most intense effect of environmental exposure was in that period, with ESKD in patients in their forties. The exposure to environmental toxicants has diminished, so ESKD of BEN has become less frequent and manifested in the older age, mean 72.5 in the period from 2004 to 2006. Different type of exposure was registered in some other endemic regions in Serbia and abroad.

目的

分析塞尔维亚南摩拉瓦地区五个地方性村庄中患有巴尔干地方性肾病（BEN）患者的血液透析（HD）治疗情况。发病率模式分析可能会产生关于BEN潜在病因的假设，而患病率数据可提供有关当前以及未来管理BEN对卫生服务造成负担的信息。

方法

1974年至2004年期间，共有143例终末期肾病（ESKD）的BEN患者进入肾脏替代治疗项目：121例接受血液透析，15例接受腹膜透析，7例接受肾脏移植。作为对照组，研究了117例在BEN患者接受血液透析时同时入院且年龄和性别相匹配的其他肾病（慢性肾盂肾炎、肾小球肾炎和缺血性肾病）患者。

结果

接受血液透析治疗的大多数BEN患者（93.4%）出生于1917年至1941年。大多数患者（79.3%）在1977年至1991年期间（15年）开始接受血液透析。1974年至1978年期间开始接受血液透析治疗的BEN患者平均年龄为49.1岁，在随后几年中稳步上升，在研究的最后阶段（2004 - 2006年）为72.5岁。BEN男性的平均生存时间为4.70（95%可信区间3.66 - 5.75），女性为5.02（95%可信区间1.47 - 4.53）。男性和女性之间的差异无统计学意义（对数秩检验0.14，p = 0.7，P > 0.5）。发现BEN患者的平均生存时间为4.84（95%可信区间3.97 - 5.70），其他肾病患者为3.1（95%可信区间2.78 - 3.84）。BEN患者与对照组之间的差异具有统计学意义（对数秩检验8.38，p = 0.0038，P < 0.01）。

结论

1974年后进入血液透析治疗的南摩拉瓦河周边地方性村庄人群在1917年至1941年期间接触了环境毒物。环境暴露的最强烈影响发生在该时期，导致四十多岁的患者出现终末期肾病。环境毒物暴露已减少，因此BEN导致的终末期肾病变得不那么常见，且在老年期出现，2004年至2006年期间平均年龄为72.5岁。在塞尔维亚和国外的其他一些地方性地区记录到了不同类型的暴露情况。