改良查尔森合并症指数联合血清白蛋白对腹膜透析患者远期预后的预测价值  

Prognostic value of modified Charlson comorbidity index combined with serum albumin for long-term prognosis in peritoneal dialysis patients

作　　者：张铭卓 张庆燕[2] 蒋春明[2] 孙琤[2] 崔元 刘莹 徐鹏飞 张苗[1] Zhang Mingzhuo;Zhang Qingyan;Jiang Chunming;Sun Cheng;Cui Yuan;Liu Ying;Xu Pengfei;Zhang Miao(Department of Nephrology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210000,China;Department of Nephrology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210000,China)

机构地区：[1]南京医科大学鼓楼临床医学院肾内科,南京210000 [2]南京大学医学院附属鼓楼医院肾内科,南京210000

出　　处：《中华肾脏病杂志》2021年第4期333-340,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金青年科学基金(81500537)。

摘　　要：目的探讨改良查尔森合并症指数(modified Charlson comorbidity index,mCCI)联合血清白蛋白(albumin,Alb)水平对腹膜透析(peritoneal dialysis,PD)患者远期预后的预测价值。方法采用回顾性队列研究分析,纳入2007年1月1日至2015年6月30日在南京鼓楼医院开始PD的患者。收集患者开始透析时的性别、年龄、基础疾病、实验室检查指标、透析充分性指标和预后等临床资料,计算开始PD时的mCCI。以PD透析龄是否超过5年作为评价预后的指标,将患者分为透析龄≥5年组和透析龄<5年组,分析并比较两组患者的临床资料,构建Cox回归模型分析PD患者全因死亡的影响因素,采用多因素Logistic回归模型及受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析mCCI及血清Alb水平对患者能否维持长期PD治疗的预测价值。结果共183例符合条件的患者被纳入最终分析,男性106例(57.9%),女性77例(42.1%);年龄(53.35±16.50)岁;合并高血压162例(88.5%),合并糖尿病55例(30.1%);其中透析龄≥5年组97例,透析龄<5年组86例;总体5年技术生存率为65.1%。PD开始时,与透析龄≥5年组相比,透析龄<5年组患者年龄更大,mCCI更高,血清白蛋白水平更低,C反应蛋白(CRP)水平更高(均P<0.05),而两组在性别、教育水平、血电解质、平均动脉压、高密度脂蛋白、低密度脂蛋白、透析充分性指标等方面差异均无统计学意义(均P>0.05)。多因素Logistic回归分析显示,年龄增加(OR=1.022,95%CI 1.000~1.043,P=0.046)、mCCI增加(OR=1.620,95%CI 1.300~2.018,P<0.001)、血清Alb水平下降(OR=0.807,95%CI 0.730~0.893,P<0.001)是PD患者透析龄<5年的独立影响因素。ROC曲线分析显示,mCCI、血清Alb水平及两者联合预测透析龄<5年的曲线下面积(AUC)分别分0.647(95%CI 0.568~0.727)、0.655(95%CI 0.577~0.734)和0.767(95%CI 0.700~0.835),以两者联合预测预后的AUC值最大。多因素Cox回归分析结果显示,年龄增加(HR=1.073,95%CI 1.Objective To assess the prognostic value of modified Charlson comorbidity index(mCCI)combined with serum albumin for long-term prognosis in peritoneal dialysis(PD)patients.Methods From January 1,2007 to June 30,2015,patients who started PD in Nanjing Drum Tower Hospital were enrolled in this retrospective cohort study.Clinical data including gender,age,underlying diseases,laboratory examination and prognosis were collected.The mCCI at the beginning of PD was calculated.Whether the duration of PD exceeded 5 years was used as an indicator to evaluate the prognosis.The patients were divided into≥5 years group and<5 years group according to the duration of PD,and the data were compared between the two groups.Cox regression model was constructed to analyze the influencing factors of all-cause death in PD patients.Multivariate logistic regression model and receiver operating characteristic(ROC)curve were used to analyze the predictive value of mCCI and serum albumin levels on whether patients could maintain long-term PD.Results Of the 183 patients included[males 106(57.9%),females 77(42.1%);(53.35±16.50)years old;162 cases(88.5%)with hypertension,55 cases(30.1%)with diabetes],97 cases had PD duration for≥5 years and 86 cases less than 5 years.The overall 5-year technical survival rate was 65.1%.At the beginning of PD,compared with the dialysis age≥5 years group,the patients in the dialysis age less than 5 years group had older age,higher mCCI,lower serum albumin level,and higher C-reactive protein(CRP)level(all P<0.05),but there were no significant differences in gender,education level,electrolyte,mean arterial pressure,high densitv lipoprotein(HDL),low-density lipoprotein(LDL)and PD adequacy index between the two groups(all P>0.05).Multivariate logistic regression analysis showed that increased age(OR=1.022,95%CI 1.000-1.043,P=0.046),increased mCCI(OR=1.620,95%CI 1.300-2.018,P<0.001)and decreased serum albumin(OR=0.807,95%CI 0.730-0.893,P<0.001)were independent predictors for the duration of PD<5 years.ROC curv

关 键 词：腹膜透析 预后 血清白蛋白 改良查尔森合并症指数 

分 类 号：R692.5[医药卫生—泌尿科学]