腹膜透析患者容量超负荷的危险因素及风险评估模型的研究  

The development of a risk prediction model for volume overload in patients with peritoneal dialysis

作　　者：赵彩萍[1] 杨春芳[1] 王丽[1] 马小琴[1] 王艳[1] 田娜[1] ZHAO Cai-ping;YANG Chun-fang;WANG Li;MA Xiao-qin;WANG Yan;TIAN Na(Department of Nephrology,Ningxia Medical University General Hospital,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肾脏内科,银川750004

出　　处：《中国血液净化》2020年第11期738-741,共4页Chinese Journal of Blood Purification

基　　金：宁夏重点研发计划一般项目(2018BEG03041)。

摘　　要：目的分析腹膜透析患者容量超负荷的独立危险因素,建立风险评估模型,为早期识别容量超负荷患者及制订干预措施提供依据。方法纳入2019年1月~12月在宁夏医科大学总医院腹膜透析中心接受透析治疗符合入组的129例腹膜透析患者。以水负荷(overdydration,OH)值来评估患者的容量状态,OH值≤2.5L为容量正常组(n=48),OH值>2.5 L为容量超负荷组(n=81),比较2组患者危险因素。结果容量超负荷组收缩压、总体水、细胞外液、细胞内液显著高于容量正常组(t/Z值分别为-2.664,-3.237,-2.572,-2.469;P值分别为0.009,0.002,0.012,0.004),而血清白蛋白、尿量显著低于容量正常组(t/Z值分别为4.514,1.979;P值分别为<0.001,0.001);多因素Logistic回归分析结果显示,尿量、收缩压、血清白蛋白是腹膜透析患者容量超负荷的独立危险因素(OR值分别为1.001,0.996,1.193;95%CI分别为1.001~1.002,0.938~0.994,1.088~1.308;P值分别为0.001,0.019,<0.001);模型的ROC曲线下面积AUC=0.845,最大约登指数0.539;该模型预测敏感性为90.1%,特异性为62.5%,总符合率73.6%。结论尿量、收缩压、血清白蛋白是腹膜透析患者容量负荷的独立危险因素。Objective To explore the independent risk factors for volume overload,and to develop a risk prediction model for volume overload in patients with peritoneal dialysis(PD).Methods A total of 129 PD patients treated in the period from January to December 2019 were recruited in this study.Overhydration(OH)value was assessed by multiple-frequency bioelectrical impedance.OH>2.5 L(n=81)was assigned as volume overload,and OH≤2.5L(n=48)as normal volume status.Clinical manifestations were compared between the two groups.Results Compare with the normal volume patient group,systolic blood pressure,total water(TBW),extracellular water(ECW)and intracellular water(ICW)were significantly higher(P<0.05),while serum albumin and residual urine volume were significantly lower in the volume overload group(P<0.05).Logistic regression analysis found that urine volume(β=0.001,OR=1.001,95%Cl 1.001-1.002,P=0.001),systolic blood pressure(β=-1.320,OR=0.966,95%Cl 0.938-0.994,P=0.019),and serum albumin(β=0.176,OR=1.193,95%Cl 1.088-1.308,P=0.000)were the independent risk factors for volume load.The ROC curve showed that AUC=0.845,the most approximate index=0.539,the predictive sensitivity=90.1%,the specificity=62.5%,and the total coincidence rate=73.6%.Conclusion Urine volume,systolic blood pressure and serum albumin were the independent risk factors for volume overload in PD patients.

关 键 词：腹膜透析 容量负荷 风险评估 预测模型 

分 类 号：R459.5[医药卫生—治疗学]