比较慢性丙型肝炎感染的终末期肾病患者中腹膜透析和血液透析治疗的生存率。

Comparing survival between peritoneal dialysis and hemodialysis treatment in ESRD patients with chronic hepatitis C infection.

机构信息

Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.

出版信息

Perit Dial Int. 2010 Jan-Feb;30(1):86-90.

PMID:20056985

Abstract

OBJECTIVE

End-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection are associated with an increasing mortality risk on hemodialysis (HD) and peritoneal dialysis (PD). The aim of this study was to compare patient survival between HCV-positive patients undergoing PD versus HD.

METHODS

We reviewed 78 PD and 78 HD patients with chronic hepatitis C infection in China Medical University Hospital from 1996 to 2006. The HD patients were selected using the propensity score matching method. Kaplan-Meier analysis with log-rank test was used to compare patient survival between patients treated with PD and those treated with HD. Possible prognostic factors were analyzed using multivariate Cox proportional hazard regression with adjustments for age, sex, and propensity score.

RESULTS

Mortality rate was 50% (39/78) for PD and 41% (32/78) for HD (chi-square test p = 0.26). Diabetes, hypertension, and cardiovascular disease were present in 43.6%, 25.6%, and 14.1% of patients, respectively. Kaplan-Meier estimate and univariate Cox regression with adjustments for age and propensity score showed that HCV patients treated with PD had a similar survival to those treated with HD (p = 0.381 and p = 0.363). In forward stepwise Cox regression, positivity for hepatitis B virus surface antigen (p < 0.001), diabetes (p = 0.009), and serum albumin (p = 0.032) were independently associated with higher mortality.

CONCLUSION

Patient survival is not different between ESRD patients with chronic hepatitis C treated with PD and those treated with HD. In ESRD patients positive for HCV, being positive for hepatitis B virus is an important prognostic factor.

摘要

目的

患有丙型肝炎病毒（HCV）感染的终末期肾病（ESRD）患者在血液透析（HD）和腹膜透析（PD）中死亡率增加。本研究旨在比较 HCV 阳性患者行 PD 与 HD 治疗的患者生存情况。

方法

我们回顾了中国医科大学附属医院 1996 年至 2006 年期间 78 例 PD 和 78 例 HD 的慢性丙型肝炎感染患者。使用倾向评分匹配法选择 HD 患者。Kaplan-Meier 分析和对数秩检验用于比较 PD 和 HD 治疗患者的生存情况。使用多变量 Cox 比例风险回归分析，并调整年龄、性别和倾向评分，分析可能的预后因素。

结果

PD 组的死亡率为 50%（39/78），HD 组为 41%（32/78）（卡方检验 p = 0.26）。分别有 43.6%、25.6%和 14.1%的患者患有糖尿病、高血压和心血管疾病。Kaplan-Meier 估计和调整年龄和倾向评分的单变量 Cox 回归显示，PD 治疗的 HCV 患者与 HD 治疗的患者生存情况相似（p = 0.381 和 p = 0.363）。向前逐步 Cox 回归分析显示，乙型肝炎病毒表面抗原阳性（p < 0.001）、糖尿病（p = 0.009）和血清白蛋白（p = 0.032）是与死亡率升高独立相关的因素。