25-羟胆钙化醇缺乏与腹膜透析相关性腹膜炎发生的相关性  

Relationship between serum 25- hydroxycholecalciferol deficiency and the risk of peritoneal dialysis associated peritonitis

作　　者：农凤伟 马云华[1] 李晓华[1] 彭熙[1] 卢晶晶[1] 廖蕴华[1] 

机构地区：[1]广西医科大学第一附属医院肾内科,南宁530021

出　　处：《中华肾脏病杂志》2017年第7期481-487,共7页Chinese Journal of Nephrology

基　　金：国家自然科学基金地区项目（81360111）;广西科学研究与技术开发计划项目（1598011-6）

摘　　要：目的探讨25-羟胆钙化醇[25（OH）D3]缺乏与腹膜透析相关性腹膜炎（PDAP）发生风险的相关关系。方法本研究为回顾性研究，病例来自2013年5月1日至2016年2月1日在广西医科大学第一附属医院肾内科接受持续性非卧床腹膜透析（CAPD）治疗并规律随访的腹膜透析患者。收集患者置管前的基线临床资料，连续随访观察至2016年7月31日。根据患者置管前基线血清25（OH）D3水平，分为25（OH）D3缺乏组[血25（OH）D3〈15ng／ml]和非25（OH）D3缺乏组[25（OH）D3≥15ng／ml]。比较两组患者的基线临床资料，采用Kaplan—Meier生存分析比较两组患者首次透析至腹膜炎发生时间的差异；Cox比例风险模型分析25（OH）D3缺乏与PDAP发生风险的相关性；受试者工作特征曲线（ROC）分析腹膜透析患者置管前血清25（OH）D3对PDAP发生风险的预测意义。结果与非25（OH）D3缺乏组相比，25（OH）D3缺乏组患者发生腹膜炎例数较多，舒张压、平均动脉压较高，血清白蛋白、总蛋白水平较低（均P〈0．05）。Kaplan-Meier生存分析结果显示，与非25（OH）D3缺乏组相比，25（OH）D3缺乏组患者首次透析至腹膜炎发生的时间缩短（P〈0．05）。Cox比例风险模型结果显示，经校正年龄、性别、血红蛋白、血清白蛋白、C反应蛋白（CRP）、总尿素清除指数（Kt／V）、估算。肾小球滤过率（eGFR）、是否合并糖尿病等因素后，25（OH）D3缺乏仍是PDAP发生的独立危险因素（HR=5．247，95％C／为1．180～23．340，P〈0．05）。ROC曲线分析结果显示，25（OH）D3缺乏预测PDAP发生的曲线下面积为0．714，其最佳截点为11．35ng／ml，敏感度为75％，特异度为63％。结论25（OH）D3缺乏的腹膜透析患者较早发生PDAP，且是PDAP发生的独立危险因素，可作为预测PDAP发生的因素之一。Objective To investigate the relationship between serum 25-hydroxycholecaleiferol [25（OH）D3] deficiency and the risk of peritoneal dialysis associated peritonitis. Methods Baseline clinical data （before the peritoneal dialysis catheter insertion） of peritoneal dialysis patients treated with CAPD in the First Affiliated Hospital of Guangxi Medical University from May 1, 2013 to February 1, 2016 were retrospective analyzed. All the patients were followed-up until July 31, 2016. According to the baseline serum 25（OH）D3 levels, patients were divided into deficiency group （25（OH）D3 〈 15 ng/ml） and non deficiency group （25（OH）D3 ≥ 15 ng/ml）, the baseline clinical data of the two groups were also analyzed. Kaplan- Meier method was used to compare the time- to- peritonitis of two groups. Cox proportional hazard model was used to analyze the relationship between the 25（OH）D3 deficiency and the risk of peritonitis. ROC curve was used to analyze the predictive value of the baseline serum 25（OH）D3 for the risk of PDAP in peritoneal dialysis patients. Results Compared with the 25（OH）D3 non deficiency group, 25（OH）D3 deficiency group had a significant increase incidence of peritonitis, high diastolic blood pressure and mean arterial pressure, but serum albumin, total serum protein decreased significantly （P 〈 0.05）. Kaplan- Meier survival analysis showed that, compared with 25（OH）D3 non deficiency group, the time-to-peritonitis episode of patients with 25（OH）D3 deficiency were shorter （P 〈 0.05）. Cox proportional hazard model showed that after adjusting for age, sex, hemoglobin, serum albumin, C-reactive protein, total Kt/V, eGFR, diabetes or not, 25（OH）D3 deficiency is the independent risk factor of peritoneal dialysis assoeiated peritonitis （HR 5.247, 95%CI 1.180-23.340, P 〈 0.05）. ROC curve showed the area under the curve that baseline serum 25（OH）D3 deficiency predict the occurrence of PDAP was 0.714, and the best cutoff point of baseline ser

关 键 词：骨化二醇 腹膜透析 腹膜透析相关性腹膜炎 

分 类 号：R692.5[医药卫生—泌尿科学]