持续C反应蛋白增高对腹膜透析患者新发合并症和预后的影响  

Prognostic Values of Persistent Elevated CRP for New Comorbidites and Survival in Peritoneal Dialysis Patients

作　　者：唐雯[1] 鲁新红[1] 汪涛[1] 

机构地区：[1]北京大学第三医院肾内科,北京100191

出　　处：《中国中西医结合肾病杂志》2010年第3期210-213,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：北京市科技计划项目(No.D09050704310905);国家自然科学基金资助项目(No.30900681);北京大学第三医院中青年骨干基金;种子基金资助项目(No.YZZ08-5-28)

摘　　要：目的:探讨持续C反应蛋白(CRP)增高对于腹膜透析患者新发合并症和生存的影响。方法:共纳入123例稳定的腹膜透析患者,根据腹膜透析患者基线及3个月后测定的血清超敏CRP(hsCRP)的水平,将患者分为持续CRP增高组(2个时间点的hsCRP均>3mg/L)和非持续CRP增高组(仅有1次CRP水平>3mg/L或CRP水平均<3mg/L的患者),记录基线资料并对两组患者进行随访,观察随访过程中的新发合并症情况及患者的临床结局。结果:在持续CRP增高组中,易发生合并症(出现合并症≥3次)的患者比例为31.3%,高于非持续CRP增高组的12.1%(P<0.05)。Logistic回归显示,持续CRP增高是患者出现新发合并症的危险因素(P<0.05)。多元COX回归模型显示,平均CRP水平是影响患者预后的因素。Kaplan-Meier生存分析显示,在非糖尿病患者中,持续CRP增高组患者的病死率高于非持续CRP增高组(P<0.05)。结论:腹膜透析患者血清hsCRP水平持续增高是患者出现新发合并症的危险因素,在非糖尿病的腹膜透析患者中,hsCRP持续增高的患者病死率高。Objective：To investigate the possible effect of persistent elevated CRP level on occurrence of new comorbidites and survival in peritoneal dialysis （PD） patients.Methods：A total of 123 prevalent peritoneal dialysis patients were included in the present study.Patients’ baseline clinic data were recorded.C-reactive protein （CRP） was measured by a high-sensitivity method.High-sensitivity C-reactive protein （hsCRP） were measured twice at an interval of 3 months during the enrollment period.And accordingly,patients were divided into two groups：the persistent elevated CRP group （peCRP group,CRP level〉3 mg/L for each time point） and the non-persistent CRP group （npeCRP group）.During the follow-up,patient’s new comorbidities were recorded and patients were followed until the occurrence of death,transferance to hemodialysis,transplantation,or censored on November 30,2009.Results：The proportion of patients who were predisposed to get new comorbidites （Episode≥3 times during the follow-up period） was higher in the peCRP group than that of in the npeCRP group （31.1% vs 12.1%,P〈0.05） Besides,the proportion of patients who easy to get new infectious comorbidites or tumor was significantly higher in the peCRP group than that of the npeCRP group （31.1% vs 9.3%,P〈0.05）.Multivariate logistic regression analysis revealed that persistent elevated CRP level was an independent predictor of new occurrence of comorbidites.Besides,multivariable Cox model showed that average CRP level was an independent predictor for patient survival.In non-diabetic patients,mortality rate was higher in the peCRP group than that of the npeCRP group （Log Rank test,P〈0.05）.Conclusion：Persistent elevated hsCRP level is a strong predictor for occurrence of new comorbidites in PD patients and in non-diabetic PD patients. Persistent elevated hsCRP is associated with high mortality.

关 键 词：C反应蛋白 腹膜透析 合并症 生存分析 

分 类 号：R459.5[医药卫生—治疗学]