糖尿病腹膜透析患者长期预后及危险因素分析  

Analysis of long-term prognosis and risk factors of diabetic peritoneal dialysis patients

作　　者：周雪丽[1] 蒋静 何学勤[1] 蒲俐 刘霞[1] 秦敏[1] 钟慧[1] ZHOU Xue-li;JIANG Jing;HE Xue-qin;PU Li;LIU Xia;QIN Min;ZHONG Hui(Department of Nephrology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院肾内科,四川成都610041 [2]四川大学华西第二医院

出　　处：《现代预防医学》2020年第24期4527-4531,共5页Modern Preventive Medicine

基　　金：四川省科技厅支撑计划(2017FZ0044)。

摘　　要：目的探讨糖尿病终末期肾脏病(end stage renal disease,ESRD)腹膜透析(PD,peritoneal dialysis)患者长期预后及相关危险因素。方法选取2011年1月—2017年12月在我院行PD置管并规律随访的患者,按原发病分为糖尿病和非糖尿病组,收集患者基本信息。利用Kaplan-Meier计算累积生存率与技术生存率,利用Cox回归模型分析患者生存危险因素。结果共647例PD患者纳入本研究,糖尿病组101例(15.61%),非糖尿病组546例(84.39%)。糖尿病组男性居多(χ2=11.829)、年龄(Z=-9.822)与体表面积(body surface area,BSA)(Z=-4.314)显著偏高、合并高血压(χ2=4.366)与心脑血管疾病者(χ2=31.12)更多,P<0.05;糖尿病组患者尿蛋白(Z=-6.035)和透析液蛋白(Z=-3.382)丢失多,P≤0.001,标准蛋白分解代谢率(normalized protein catabolic rate,n PCR)低(Z=-3.189),D/PCr(4h)更高(Z=-3.598),P<0.001。糖尿病和非糖尿病组患者第1、3、5年的累积生存率(P=0.037)分别为95.43%、87.11%、54.12%和98.14%、87.64%、78.61%,累积生存率低于非糖尿病组患者;两组患者技术生存率相似分别为91.62%、66.52%、46.31%和94.51%、74.83%、58.64%,无统计学差异(P=0.094)。多因素分析得出年龄、血清白蛋白、血红蛋白和心脑血管疾病是糖尿病PD患者生存的独立危险因素。结论第1、3、5年累积生存率低于非糖尿病组患者,技术生存率相似。年龄、血清白蛋白、血红蛋白和心脑血管疾病是糖尿病PD患者生存的独立危险因素。Objective To investigate long-term prognosis and related risk factors in patients with end-stage renal disease(ESRD)peritoneal dialysis(PD).Methods PD patients were selected from our hospital from January 2011 to December 2017 and regularly followed up.According to the primary disease,patients were divided into diabetic and non-diabetic groups.Cumulative and technical survival rates were calculated by Kaplan-Meier,and risk factors were analyzed by Cox regression model.Results A total of 647 PD patients were included in this study,including 101 patients in the diabetes group(15.61%)and 546 patients in the non-diabetes group(84.39%).In the diabetes group,the majority of males(χ2=11.829)were significantly higher in age(Z=-9.822)and body surface area(BSA)(Z=-4.314),and more were associated with hypertension(χ2=4.366)and cardiovascular and cerebrovascular diseases(χ2=31.12),P<0.05.In the diabetic group,urine protein(Z=-6.035)and dialytic protein(Z=-3.382)lost more,P≤0.001,the normalized protein Catabolic rate(nPCR)(Z=-3.189)is low,D/PCr(4 h)is higher(Z=-3.598),P<0.001.The cumulative survival rates at the first,third and fifth years(P=0.037)were 95.43%,87.11%,54.12%,98.14%,87.64%and 78.61%,respectively,which were lower than those in the non-diabetic group.The technical survival rates of the two groups were similar(91.62%,66.52%,46.31%,94.51%,74.83%,58.64%),with no statistical difference(P=0.094).Multivariate analysis showed that age,serum albumin,hemoglobin and cardiovascular and cerebrovascular diseases were independent risk factors for the survival of PD patients with diabetes.Conclusion The cumulative survival rate at 1,3 and 5 years was lower than that of the non-diabetic group,and the technical survival rate was similar.Age,serum albumin,hemoglobin and cardiovascular and cerebrovascular diseases are independent risk factors for the survival of PD patients with diabetes.

关 键 词：腹膜透析 糖尿病 长期预后 危险因素 

分 类 号：R589[医药卫生—内分泌]