长期腹膜透析患者的特征  

Characteristics of long-term survivors on peritoneal dialysis

作　　者：林爱武[1] 钱家麒[1] 方炜[1] 倪兆慧[1] 严豪[1] 曹励欧[1] 林星辉[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科上海市腹膜透析研究中心,200001

出　　处：《中华肾脏病杂志》2008年第12期868-871,共4页Chinese Journal of Nephrology

基　　金：基金项目：上海市科委课题（044119620）

摘　　要：目的评价长期腹膜透析患者的特征。方法选取1994年在本中心开始透析且持续透析1年以上的患者。按照透析时间，将患者分为两组：A组（长期透析组）为持续透析5年以上；B组（短期透析组）为在5年之内由于转血液透析或死亡而退出的患者。比较两组患者的一般情况、生化指标、透析处方及充分性。结果符合要求的患者，A组有68例，B组98例。平均随访时间A组为（84．80±19．42）月；B组为（27．25±12．31）月。A组患者年龄较轻；合并糖尿病（A组3／68比B组18／98，P〈0．05）和冠心病（A组6／68比B组22／98，P〈0．05）较少；开始透析时血清白蛋白较高[A组（35．56±4．74）g／L比B组（33．69±5．45）g／L，P〈0．01]。两组间血糖、血脂、血红蛋白和钙磷指标差异无统计学意义。开始透析时A组的残肾GFR、残肾Kt／V和残肾Ccr较B组高（P〈0．05），但尿量在两组问差异无统计学意义。A组尿量和残肾GFR的下降速度较B组慢。随访过程中，A组腹膜炎的发生率显著低于B组（1／81．22月比1／29．03月，P〈0．01），这种差异在转血液透析的患者中尤其明显。结论与短期透析患者相比，长期腹膜透析患者具有相对年轻、并发糖尿病和冠心病的发生率较少、开始透析时营养状态较好、残肾功能较好、脉压差较小、透析后残肾功能下降速度慢及腹膜炎发生率相对少的特点。Objective To evaluate the characteristics of patients on long-term peritoneal dialysis （PD）. Methods Patients who started PD since 1994 and received PD for at least one year were included in this study. According to dialysis duration, patients were divided into two groups. Group A （long-term） was defined as patients survived on PD for more than 5 years. Group B （short-term） was defined as patients who died or switched to hemodialysis within less than 5 years. Demography, biochemical indexes, dialysis prescription and adequacy were compared between two groups. Results There were 68 patients in group A and 98 patients in group B. Mean followed-up period of group A and B was （84.80±19.42） months and （27.25±12.31） mouths, respectively. Younger, fewer episodes of diabetic comorbidity （group A 3/68 vs group B 18/98, P 〈0.05） and coronary heart disease （group A 6/68 vs group B 22/98, P〈O.05） were found in group A. Compared to group B, the level of serum albumin at the beginning of PD was much higher in group A [（35.56±4.74） g/L vs （33.69±5.45） g/L, P〈0.01）. The levels of blood sugar, TC, TG, hemoglobin, calcium, phosphate and iPTH were not significantly different between two groups. Estimated GFR, renal Kt/V and renal Ccr at the beginning of dialysis were much higher in group A, however there was no significant difference in urinary volume between two groups. Both estimated GFR and urinary volume decreased more slowly in group A compared to group B. Peritonitis mobidity was lower in group A （1/81.22 months vs 1/29.03 months, P〈0.01）. Conclusions In comparison to short-term survivors, long-term PD patients are characterized by being younger, less diabetic and coronary heart disease, fewer episodes of peritonitis, higher level of serum albumin, higher estimated GFR and less loss of residual renal function.

关 键 词：腹膜透析 存活率 腹膜炎 残肾功能 

分 类 号：R459.5[医药卫生—治疗学] R572.2[医药卫生—临床医学]