终末期肾病腹膜透析患者退出治疗危险因素分析  

Risk factors for peritoneal dialysis drop-out in patients with end-stage kidney disease

作　　者：陈旭娇[1] 庹素馨[1] 陶煜[1] 卞蓉蓉[1] 邢小红[1] 潘晓红[1] 陈娟娟[1] 毛志国[1] 

机构地区：[1]第二军医大学长征医院肾内科,解放军肾脏病研究所,上海200003

出　　处：《第二军医大学学报》2016年第1期27-33,共7页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金面上项目(81570621);中华医学会临床医学科研专项资金-施维雅肾脏病青年研究与发展资金(13030340419);“十二五”国家科技支撑计划(2011BAI10B08)~~

摘　　要：目的分析进入腹膜透析（peritoneal dialysis,PD）终末期肾病（end-stage kidney disease,ESKD）患者基线的相关检测指标和临床资料,探究可能影响PD患者最终退出的危险因素,为患者透析方式的选择提供参考。方法回顾性分析2011年7月至2012年7月第二军医大学长征医院PD中心99例ESKD行PD管植入术且临床资料完整的患者信息,根据患者在随后3年内是否退出PD将其分为退出组（包括死亡组和转血液透析组）和维持PD组,对术前相关检测指标和临床资料进行相关性分析,探究可能影响PD退出的危险因素。结果在排除肾移植（10例）及失访（6例）后,共有83例纳入分析。维持PD组50例,退出组33例,其中死亡19例,转血液透析14例。多因素逐步Cox回归分析提示,患者术前患有糖尿病（P=0.003,HR：3.61,95%CI：1.57~8.30）、高磷血症（P〈0.001,HR：1.65,95%CI：1.26~2.13）、高血清总胆红素（P=0.006,HR：1.11,95%CI：1.03~1.19）是影响患者退出PD的独立危险因素;除上述指标外,年龄（P=0.035,HR：1.05,95%CI：1.00~1.07）、低血红蛋白（P=0.016,HR：0.96,95%CI：0.94~0.99）是影响PD患者死亡的独立危险因素。结论糖尿病、高磷血症、高血清总胆红素是影响PD患者退出的独立危险因素。Objective To analyze the baseline detection indicator and clinical data of peritoneal dialysis （PD） patients with end-stage kidney disease （ESKD） and to identify the risk factors for PD drop-out in ESKD patients, so as to provide reference for selecting dialysis modes. Methods The baseline data of 99 ESKD patients starting to receive PD in Changzheng Hospital, Second Military University from July 2011 to July 2012, were analyzed retrospectively. The patients were divided into drop-out group （including patients who were dead and turned to hemodialysis ） and continuous PD group according to whether they were dropped out during a follow-up of 3 years. Correlation analysis was done for preoperative examination indices and clinical data to identify the risk factors of PD drop-out. Results Ten renal transplant patients and 6 who were lost in follow-up were excluded and finally there were 83 patients included. Fifty patients were in the continous PD group and 33 patients were dropped out during a 3-year follow-up period, with 19 died and 14 transferred to hemodialysis. Multivariate Cox regression analysis showed that presence of diabetes （P=0. 003, HR： 3. 61, 95% CI： 1.57-8. 30）, hyperphosphatemia （P〈0. 001, HR： 1.65, 95% CI： 1.26-2.13）, and high serum total bilirubin （P=0. 006, HR： 1.11, 95% CI： 1.03-1.19） were the independent risk factors of PD drop-out. In addition, age （P=0. 035, HR： 1. 05, 95% CI： 1. 00-1. 07） and anemia （P=0. 016, HR.. 0. 96, 95% CI：0. 94=- 0. 99） were the independent risk factors for all-caused mortality. Conclusion Presence of diabetes, hyperphosphatemia, and high serum total bilirubin are possible independent risk factors of PD drop-out.

关 键 词：终末期肾病 腹膜透析 危险因素 COX回归分析 总胆红素 

分 类 号：R692[医药卫生—泌尿科学]