腹膜透析患者体质量指数与预后的相关关系  

Association between body-mass index and survival in peritoneal dialysis patients

作　　者：王奕[1] 齐华林[1] 江薇[1] 张瑞青[1] 刘峰[1] 王俊[1] 张颖莹[1] 严海东[1] 庄守纲[1] 

机构地区：[1]上海市东方医院肾内科,200120

出　　处：《中华肾脏病杂志》2014年第10期744-750,共7页Chinese Journal of Nephrology

基　　金：上海市浦东新区科技发展创新基金（PKJ2011-Y04）;浦东新区卫生系统优秀青年医学人才基金（PWRq2008-12）;浦东新区卫生系统重点学科建设基金（PWZx2014-06）

摘　　要：目的 研究腹膜透析（PD）患者的体质量指数（BMI）与预后的相关关系.方法 回顾性分析2008年1月始在本院接受CAPD治疗的81例患者临床资料,按BMI分为低体质量组（BMI＜ 18.5 kg/m2）;正常体质量组（18.5 ～ 23.9 kg/m2）;超体质量组（24 ～ 27.9 kg/m2）和肥胖组（BMI≥28 kg/m2）.连续观察36个月,截止时间2013年12月.采用Kaplan-Meier法比较81例患者的生存率和技术生存率,Cox比例风险模型分析BMI与预后的关系.结果 与正常体质量组相比,低体质量组和肥胖组患者的累积生存率显著下降（均P＜ 0.01）;超体质量组累积生存率差异无统计学意义;肥胖组患者的技术生存率显著降低（P＜0.01）;超体质量组和低体质量组技术生存率差异无统计学意义.腹膜透析技术失败的主要原因为腹膜炎（81.3％）.CAPD患者的BMI与白蛋白（r=0.24,P＜0.05）、血红蛋白（r=0.56,P＜0.01）、血糖（r=0.23,P＜0.05）、胆固醇（r=0.41,P＜ 0.01）呈正相关,与总Kt/V（r=-0.36,P＜ 0.01）、Ccr（r=-0.34,P＜ 0.01）呈负相关.经校正后的Cox比例风险模型结果提示,与正常体质量组相比,肥胖组PD患者的死亡风险明显增加（HR：5.93,95％CI：1.10 ～ 31.79）.肥胖（HR：10.33,95％CI：1.04 ～ 78.02）和腹膜炎（HR：2.74,95％CI：1.17 ～ 6.40）是腹膜透析技术失败的独立危险因素.结论 低体质量和肥胖的CAPD患者生存率较低,肥胖的CAPD患者技术生存率最低;肥胖可能是影响CAPD患者生存的独立危险因素.Objective To evaluate the association between body-mass index and prognosis in peritoneal dialysis （PD） patients.Methods In this observational study of a single nephrology unit in Shanghai East Hospital,81 incident continuous ambulatory peritoneal dialysis（CAPD） patients were included from Jan 2008 to Dec 2013,whom were followed-up by 36 months or until death.The patients were classified as underweight （BMI ＜ 18.5 kg/m2）; normal weight （18.5 ～ 23.9 kg/m2）; overweight （24 ～ 27.9 kg/m2） and obese （BMI≥28 kg/m2）.The patients and technique survival rates were estimated by Kaplan-Meier analysis.Cox proportional hazards analyses were used to elucidate relationship between BMI and all-cause mortality and technique failure in PD patients.Results The overall survival rate was similar between normal and overweight groups （P=0.96）,but significantly lower in underweight group and obese group （P ＜ 0.01 respectively）.The overall technical survival rate of obese group was lower compare with normal group （P ＜ 0.01）.The main cause of technical failure was peritonitis （81.3％）.BMI was positively correlated with albumin （r=0.24,P ＜ 0.05）,hemoglobin （r=0.56,P ＜ 0.01）,glucose（r=0.23,P＜0.05） and cholesterol （r=0.41,P＜0.01）,but negatively correlated with Kt/V （r=-0.36,P ＜ 0.01） and Ccr（r=-0.34,P ＜ 0.01）.In adjusted Cox proportional hazard mode 3,obese was independently associated with all-cause mortality （HR：5.93,95％ CI：1.10～31.79）.Obese and peritonitis were independently associated with technical failure （HR：10.33,95％CI：1.04～ 78.02 and HR：2.74,95％ CI：1.17 ～ 6.40 respectively）.Conclusions Underweight and obese CAPD patients have poorer outcome.Obese CAPD patients also have lower technical survival rate.Obesity was an independent risk factor for all-cause mortality in CAPD patients.

关 键 词：人体质量指数 腹膜透析 生存分析 

分 类 号：R459.5[医药卫生—治疗学]