腹膜透析治疗终末期糖尿病肾脏病与非糖尿病肾脏病的疗效比较  

Comparison of Efficacy of Peritoneal Dialysis for End-stage Diabetic Kidney Disease and Non-diabetic Kidney Disease

作　　者：白田丽 于青[1] BAI Tianli;YU Qing(Department of Nephrology,Shanghai General Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200080,China;Department of Nephrology,Shanghai Putuo District Central Hospital,Shanghai 200062,China)

机构地区：[1]上海交通大学附属第一人民医院肾内科,上海200080 [2]上海市普陀区中心医院肾内科,上海200062

出　　处：《医学综述》2020年第23期4764-4768,共5页Medical Recapitulate

摘　　要：目的探讨维持性腹膜透析治疗终末期糖尿病肾脏病(DKD)及非糖尿病肾脏病(NDKD)的疗效。方法选取2010年1月至2019年8月于上海市普陀区中心医院肾内科接受腹膜透析治疗的150例终末期肾病患者为研究对象,按照原发病将其分为DKD组(n=56)及NDKD组(n=94),分别收集两组患者透析起始和透析后不同阶段各项临床指标及透析评估结果、预后等资料,比较两组生化指标及并发症发生情况。绘制生存曲线,分析两组患者生存率差异及影响DKD患者生存率的相关因素。结果选取技术生存率满足6个月的99例患者进行分析,其中DKD组33例,NDKD组66例,治疗前后尿量、白蛋白、三酰甘油、总胆固醇、收缩压及舒张压的主效应差异有统计学意义(P <0.05);不考虑测量时间,两组间上述各指标的主效应差异有统计学意义(P <0.05);各指标的组间与时点间存在交互作用(P <0.05),NDKD组各指标改善更显著。NDKD组总并发症发生率低于DKD组[12.77%(12/94)比44.64%(25/56)](P <0.01)。随访48个月,NDKD组患者生存率明显高于DKD组(P <0.05),结合DKD组患者腹膜透析6个月时的一般临床资料与生存情况进行Logistic多因素回归分析显示,年龄(OR=0.111,95%CI 0.054~0.213)、血清白蛋白(OR=1.895,95%CI 1.723~2.167)及并发症(OR=0.265,95%CI 0.054~0.466)是DKD患者生存的独立影响因素(P <0.05)。结论腹膜透析是治疗终末期DKD及NDKD的有效手段,与DKD患者相比,治疗后NDKD患者各生化指标改善更好,相关并发症的发生率更低,生存率较高,故临床上应更加关注腹膜透析治疗的DKD患者。Objective To study the efficacy of peritoneal dialysis for end-stage diabetic kidney disease(DKD)and non-diabetic kidney disease(NDKD).Methods From Jan.2010 to Aug.2019,150 patients with end-stage renal disease treated with peritoneal dialysis in the Department of Nephrology,Shanghai Putuo District Central Hospital were included.According to the primary disease,they were divided into a DKD group(n=56)and a NDKD group(n=94),and the biochemical indexes and complications were compared between the two groups.The survival curve was drawn to analyze the difference of survival rate between the two groups and the related factors affecting the survival rate of DKD patients.Results Altogether 99 patients with technical survival rate of 6 months were selected for analysis,including 33 cases in the DKD group and 66 cases in the NDKD group.The main differences in effects of urine volume,albumin,triglyceride,total cholesterol,systolic blood pressure and diastolic blood pressure before and after treatment were statistically significant(P<0.05);without considering the measurement time,the main effect differences of the above indicators between the two groups were statistically significant(P<0.05);there was interaction of each index between time points and group(P<0.05),and the improvement was more obvious in the NDKD group.The incidence of overall complications in the NDKD group was lower than that in the DKD group[12.77%(12/94)vs 44.64%(25/56)](P<0.01).After 48 months of follow-up,the survival rate of the NDKD group was significantly higher than that of the DKD group(P<0.05).Logistic regression analysis on the general clinical information and patient survival at 6 months of peritoneal dialysis showed that age(OR=0.111,95%CI 0.054-0.213),serum albumin(OR=1.895,95%CI 1.723-2.167),and complications(OR=0.265,95%CI 0.054-0.466)were independent influencing factors for the survival of DKD patients(P<0.05).Conclusion Peritoneal dialysis is an effective treatment of end-stage DKD and NDKD.Compared with DKD patients,the biochemical index

关 键 词：糖尿病肾脏病 非糖尿病肾脏病 腹膜透析 腹膜透析相关感染 心脑血管事件 生存率 

分 类 号：R692.9[医药卫生—泌尿科学] R459.5[医药卫生—外科学]