终末期肾病患者持续性非卧床腹膜透析对铁代谢及预后的影响  

The effect of persistent peritoneal dialysis on iron metabolism and prognosis in patients with end stage renal disease

作　　者：贺丽娟[1] 梁伟[1] 王青[1] 李玲艳 熊子波[1] HE Lijuan;LIANG Wei;FANG Qing;LI Lingyan;XIONG Zibo(Department of Nephrology,Shenzhen Hospital,Peking University,Guangdong,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院肾内科,518036

出　　处：《疑难病杂志》2018年第8期794-798,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：深圳市科技计划项目(20120321030)

摘　　要：目的观察终末期肾病持续性非卧床腹膜透析(CAPD)患者对铁代谢状态及预后的影响。方法回顾性分析2013年6月-2014年12月北京大学深圳医院肾内科腹膜透析中心接受3个月以上CAIPD治疗的患者173例的临床资料,根据转铁蛋白饱和度分为观察组(转铁蛋白饱和度<20%)137例和对照组(转铁蛋白饱和度≥20%)36例,对比2组患者的临床资料(包括性别、年龄、透析龄、血红蛋白、Alb、前白蛋白、肌酐、尿酸、Npcr、KT/V、CRP、血清铁、转铁蛋白饱和度、铁蛋白及PTH),对可能影响CAPD患者铁代谢异常的相关因素进行多因素Logistic回归分析。采用Kaplan-Meier生存分析计算患者的1、3年累积生存率。结果与对照组比较,观察组铁代谢指标((血清铁、转铁蛋白饱和度、铁蛋白)较低,PTH及CRP较高,差异有统计学意义(t=7.222、7.816、4.702、4.397、7.060,P均=0.000),且观察组残余肾功能、营养状况及透析充分性较差(t=13.978、3.257、2.524、3.573、3.435、2.411,P=0.000、0.003、0.013、0.000、0.001、0.017);Pearson单因素相关性分析显示,血清铁、转铁蛋白饱和度与年龄、Hb、KT/V呈正相关(r=0.837/0.831、0.657/0.662、0.577/0.665,P=0.000/0.000、0.001/0.004、0.004/0.010),与CRP、PTH、前白蛋白、肌酐呈负相关(r=-0.751/-0.792、-0.613/-0.654、-0.585/-0.659、-0.545/-0.567,P=0.000/0.000、0.018/0.007、0.028/0.009、0.037/0.045);铁蛋白与CRP、PTH、前白蛋白呈正相关(r=0.851、0.816、0.652,P=0.000、0.000、0.011),与年龄、Hb、ALb、Npcr、KT/V呈负相关(r=-0.886、-0.761、-0.584、-0.486、-0.596,P=0.000、0.000、0.037、0.049、0.021)。Logistic回归分析显示,发生铁代谢异常的可能预测因素为年龄、KT/V、Hb及前白蛋白。Kaplan-Meier分析显示,对照组的1、3年累积生存率分别为97.22%、94.44%,明显高于观察组的83.94%、78.83%,差异均有统计学意义(χ~2=4.362、4.75、5.257,P=0.038、0.030,0.022)。结论终末期肾病持续性不�Objective To observe the effect of iron metabolism on the prognosis of patients with persistent peritoneal dialysis persistent peritoneal dialysis（ CAPD）. Methods The clinical data of 173 patients undergoing CAPD therapy for more than 3 months at the peritoneal dialysis center of Shenzhen University from September 2013 to December 2014 were retrospectively analyzed. The patients were divided into observation groups（transferrin） according to the hemoglobin level（ Hb）.Transferrin saturation was 〈20% in 137 cases and control group（transferrin saturation ≥20%） in 36 cases. Comparing the clinical data of patients in two groups（including： sex, age, dialysis age, hemoglobin, ALb, pre-albumin, creatinine, uric acid, Npcr, KT/V,CRP, serum iron,transferrin saturation, ferritin And PTH）, multivariate logistic regression analysis of factors that may affect iron metabolism abnormalities in patients with CAPD was performed. Kaplan Meier survival analysis was used to calculate the patient＇s cumulative survival rate of 1, 3 years. Results Compared with the observation group, the iron metabolism index, PTH and inflammatory index were lower in the control group, the difference was statistically significant（t=7.222,t=7.816,t=4. 702,t=4.397,t=7.060,P=0.000）,and the control group maintained kidney function,nutritional status and adequacy of dialysis were better（t=13. 978, t =3.257, t = 2. 524, t =3.573, t =3.435, t =2.411, respectively;P = 0. 000, P = 0.003, P = 0. 013, P = 0. 000, P =0. 001, P = 0.017, respectively）; Pearson＇s single factor correlation Sex analysis showed that serum iron and transferrin saturation were positively correlated with age, Hb, and KT/V（ r =0.837/0.831, r= 0.657/0.662, r =0.577/0. 665, respectively, P =0.000/0. 000, P =0. 001/0.004, P =0.004/0. 010,respectively）, and negative correlated with CRP, PTH, pre-albumin and creatinine（r =-0. 751/0. 792, r =0.613/-0.654, r=-0.585/-0.659, r=-0.545/-0. 567, P =0.000/0. 000, P = 0.018/0.007, P= 0.028/0. 009, P =0.037/0. 045

关 键 词：终末期肾病 持续性不卧床腹膜透析 铁代谢 预后 

分 类 号：R692.5[医药卫生—泌尿科学]