腹膜蛋白清除率对腹膜透析患者心血管预后的预测价值  

Value of peritoneal protein clearance as a predictor of cardiovascular outcomes in peritoneal dialysis patients

作　　者：牛威 杨晓晓 沈亦蔚 马大骅 徐奕玫 宋倩徽 俞赞喆[1] 严豪[1] 李振元[1] 倪兆慧[1] 方炜[1] Niu Wei;Yang Xiaoxiao;Shen Yiwei;Ma Dahua;Xu Yimei;Song Qianhui;Yu Zanzhe;Yan Hao;Li Zhenyuan;Ni Zhaohui;Fang Wei(Department of Nephrology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University Shanghai Research Center for Peritoneal Dialysis,Shanghai 200127,China;Department of Nephrology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海交通大学医学院附属仁济医院肾脏内科上海市腹膜透析研究中心,上海200127 [2]复旦大学附属中山医院肾脏内科,上海200032

出　　处：《中华肾脏病杂志》2021年第7期576-582,共7页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81370864,81670691);上海市教育委员会高峰高原学科建设计划(20152211)。

摘　　要：目的:探讨腹膜蛋白清除率(peritoneal protein clearance,Pcl)对腹膜透析(腹透)患者心血管预后的预测价值。方法:本研究为前瞻性队列研究。入选2014年1月至2015年4月在上海交通大学医学院附属仁济医院腹透中心规律随访且透析龄>3个月的患者。所有患者随访至死亡、退出腹透、转其他中心或研究终止日期(2018年10月1日)。按Pcl的中位数将患者分为高Pcl组和低Pcl组,比较两组腹透患者相关指标的差异。采用多元线性回归模型分析Pcl的相关影响因素。采用Kaplan-Meier法和Log-rank检验比较两组患者的累积生存率。采用多因素Cox回归模型分析Pcl对腹透患者心血管疾病事件和心血管疾病死亡的预测作用。结果:本研究共入选271例患者,其中男性135例(49.8%),年龄(56.92±0.84)岁,中位腹透龄38.77(19.00,63.10)个月,合并糖尿病70例(25.8%),有心血管疾病史81例(29.9%),中位Pcl为67.93(52.31,88.36)ml/d。与低Pcl组(Pcl<67.93 ml/d)相比,高Pcl组(Pcl≥67.93 ml/d)患者年龄、合并心血管疾病比例、体重指数、脉压差、脑钠肽和肌酐的物质转运面积系数(mass transfer area coefficient of creatinine,MTACcr)均较高,血清白蛋白较低(均P<0.05)。两组患者性别、透析龄、合并糖尿病比例、血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂比例、持续性非卧床腹透比例、超敏C反应蛋白、24 h尿量、24 h超滤量和残余肾功能之间的差异均无统计学意义(均P>0.05)。多元线性回归分析结果显示,血清白蛋白(β=-0.388,P<0.001)、体重指数(β=0.189,P<0.001)和MTACcr(β=0.247,P<0.001)与lg(Pcl)独立相关。研究期间,发生心血管疾病事件55例,心血管疾病死亡39例。Kaplan-Meier生存分析结果显示,高Pcl组患者心血管疾病病死率著高于低Pcl组(Log-rankχ^(2)=6.902,P=0.009)。多因素Cox回归分析结果显示,高lg(Pcl)是腹透患者发生心血管疾病事件的独立影响因素(HR=7.654,95%CI 1.676~34.9Objective To investigate the predictive value of peritoneal protein clearance(Pcl)for cardiovascular events and cardiovascular mortality in peritoneal dialysis(PD)patients.Methods Eligible PD patients were prospectively enrolled from January 2014 to April 2015 in the PD Center of Renji Hospital,School of Medicine,Shanghai Jiao Tong University.All patients were followed up until death,withdrawing from PD,transferring to other centers,or the end of study period(October 1,2018).The patients were divided into high Pcl group and low Pcl group by the median Pcl,and the differences of related indicators between the two groups were compared.A multiple linear regression model was used to analyze the influencing factors of Pcl.The Kaplan-Meier method and Log-rank test were used to compare the cumulative survival rates of patients between the two groups.A multivariate Cox regression model was used to estimate the risk of cardiovascular events and cardiovascular mortality in relation to Pcl in PD patients.Results A total of 271 patients were enrolled,with 135 males(49.8%),age of(56.92±0.84)years old and a median PD duration of 38.77(19.00,63.10)months.There were 70 patients(25.8%)comorbiding with diabetes and 81 patients(29.9%)with cardiovascular diseases(CVD).The median Pcl of this cohort was 67.93(52.31,88.36)ml/d.Compared with the low Pcl group(Pcl<67.93 ml/d),the high Pcl group(Pcl≥67.93 ml/d)had older age,and greater proportion of CVD,body mass index(BMI),pulse pressure,brain natriuretic peptide,mass transfer area coefficient of creatinine(MTACcr),and lower serum albumin(all P<0.05).There was no significant difference in gender,dialysis duration,proportion of diabetes,proportion of angiotensin converting enzyme inhibitor and angiotensin receptor blocker,proportion of continuous ambulatory PD,high sensitivity C reactive protein,fluid removal including 24 h urine volume and 24 h ultrafiltration,and residual renal function between the two groups(all P>0.05).Multiple linear regression analysis showed that serum albumin(�

关 键 词：腹膜透析 心血管疾病 预后 腹膜蛋白清除率 

分 类 号：R459.5[医药卫生—治疗学]