腹膜透析掉队数据评估行腹膜透析影响因素  

Evaluation of the influencing factors for the peritoneal dialysis patients dropped out of peritoneal dialysis

作　　者：杨春慧 严月华 姚烨 李岩[1] 杨笑筠[1] 纪天蓉[1] 孔凡武[1] YANG Chun-hui;YAN Yue-hua;YAO Ye;LI Yan;YANG Xiao-jun;JI Tian-rong;KONG Fan-wu(Department of Nephrology,The Second Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第二医院肾内科,哈尔滨150000

出　　处：《中国血液净化》2020年第9期598-601,共4页Chinese Journal of Blood Purification

基　　金：黑龙江省博士后科学基金(LBH-Z18128);中国博士后科学基金(2017M610213)。

摘　　要：目的分析不同透析龄掉队患者进入腹膜透析(peritoneal dialysis,PD)前实验室检查及患者临床特点,评估患者行腹膜透析的的影响因素,从而选择更为合适的透析方式,提高患者生活质量。方法回顾性分析2009年1月~2019年12月哈尔滨医科大学附属第二医院肾内科PD掉队患者的临床资料,共262例。所有患者均采用百特1.5%或2.5%腹膜透析液2000ml/次,每日至少规律透析3次。根据透析龄分为:A组:透析龄≤1年(96例),B组:1年<透析龄<3年(100例),C组:透析龄≥3年(66例),比较各组患者进入PD前临床特点及实验室检查结果。结果共纳入PD掉队患者262例,与C组患者相比,A组患者血浆白蛋白水平、总蛋白水平和女性比例更低(t/Z/χ^2值分别为9.204,-2.503,3.905;P值分别为0.002,0.013,0.048);出现心血管系统并发症(心悸及活动后胸闷)的比例更高(29.17%比6.06%,χ^2=13.311,P=0.001);出现消化系统并发症(恶心、便秘、腹泻)的比例更高(41.67%比13.64%,χ^2=15.567,P=0.001)。多因素Logistic回归分析发现,血浆白蛋白水平是早期腹膜透析掉队的独立危险因素(OR:1.106,95%CI:1.004~1.217,P=0.040)。另外,线性相关分析结果显示血浆白蛋白与透析龄呈正相关(r=0.153,P=0.015)。结论男性,透析前营养状态差,心血管系统并发症及消化系统并发症明显的腹膜透析患者更容易早期掉队,或许应优选血液透析,血浆白蛋白水平是早期腹膜透析掉队的独立危险因素。Objective To analyze laboratory indexes and clinical characteristics of the patients dropped out of peritoneal dialysis(PD)at different dialysis age before rEentering PD,and to evaluate the influencing factors for PD,so as to choose an appropriate way of dialysis and to improve the quality of life of these patients.Methods We retrospectively analyzed the clinical data of 262 PD patients who dropped out of PD in the Department of Nephrology,The Second Affiliated Hospital of Harbin Medical University from January 2009 to December 2019.They were treated with 2000 ml Baxter 1.5%or 2.5%peritoneal dialysate at least three times a day.They were divided into three groups according to the dialysis age:group A,dialysis age≤1 year(n=96);group B,dialysis age>1 year and<3 years(n=100);and group C,dialysis age≥3 years(n=66).Their laboratory indexes and clinical characteristics before rEentering PD were compared.Results Compare with those in group C,patients in group A had lower plasma albumin and total protein,lower proportion of female(t,Z andχ^2=9.204,-2.503 and 3.905 respectively;P=0.002,0.013 and 0.048 respectively),and higher prevalence of cardiovascular complications(palpitation and chest tightness after exercise)(29.17%vs.6.06%,χ^2=13.311,P=0.001)and digestive system complications(nausea,constipation,diarrhea)(41.67%vs.13.64%,χ^2=15.567%,P=0.001).Multivariate logistic regression analysis showed that plasma albumin level was the independent risk factor for early PD withdrawal(OR:1.106,95%CI:1.004~1.217,P=0.040).In addition,linear correlation analysis showed that plasma albumin and dialysis age were positively correlated(r=0.153,P=0.015).Conclusion Male patients,and patients with poor nutritional status before dialysis and apparent cardiovascular and digestive system complications were more likely to drop out of PD earlier.Hemodialysis may be suitable for them.Plasma albumin level was an independent risk factor for early withdrawal of PD.

关 键 词：腹膜透析 掉队 尿毒症 

分 类 号：R44[医药卫生—诊断学]