早期葡萄糖暴露量与腹膜透析相关性腹膜炎发生风险的关系研究  

Relationship between early giucose exposure in peritoneal dialysis and risk of peritoneal dialysis-offiliated peritonitis

作　　者：肖拓 尚进[1] 马爽[1] 张丽洁 武彤 陈奎 肖静[1] XIAO Tuo;SHANG Jin;MA Shuang;ZHANG Li-jie;WU Tong;CHEN Kui;XIAO Jing(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肾脏内科,郑州450052

出　　处：《医药论坛杂志》2021年第9期1-6,共6页Journal of Medical Forum

基　　金：国家自然科学基金青年基金(81400763)。

摘　　要：目的探讨腹膜透析(peritoneal dialysis,PD)早期葡萄糖暴露量(glucose exposure)与腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis,PDAP)发生风险的关系。方法本研究为单中心回顾性队列研究,选取2015年1月1日至2018年12月31日在郑州大学第一附属医院腹膜透析中心规律PD患者,对患者的人口学资料和临床检验数据进行统计分析。依据PD治疗后6周、6个月和12个月后葡萄糖暴露量中位数,将患者分为高葡萄糖暴露量组和低葡萄糖暴露量组。采用Cox比例风险回归模型分析葡萄糖暴露量和PDAP之间的相关性。采用χ^(2)检验分析高、低葡萄糖暴露量患者PDAP发病率的差异性。采用Kaplan-Meier生存曲线分析高、低葡萄糖暴露量患者初次PDAP发生时间的差异性。结果共有227例患者纳入本研究,在中位21(14,33)个月的随访期内,有56例患者发生了腹膜炎。单因素Cox回归分析结果显示6周时葡萄糖暴露量是PDAP发生的独立危险因素(HR=1.929,95%CI 1.033~3.600,P=0.039)。经校正协变量年龄、血红蛋白、血糖、总胆固醇和铁蛋白后,多因素Cox回归分析结果显示6周葡萄糖暴露量仍是PDAP发生的独立危险因素(HR=2.165,95%CI 1.066~4.397,P=0.033)。χ^(2)检验分析结果示,6周时高葡萄糖暴露量患者PDAP发病率更高(χ^(2)=6.480,P=0.011)。Kaplan-Meier生存曲线分析结果示,与低葡萄糖暴露量患者相比,6周和6个月时高葡萄糖暴露量患者初次PDAP发生的时间更早[(Log-rankχ^(2)=10.180,P=0.001)和(Log-rankχ^(2)=3.992,P=0.046)]。结论早期腹膜透析高葡萄糖暴露量患者PDAP发病率高且发生时间早,葡萄糖暴露量是PDAP的独立危险因素。Objective To investigate the relationship between glucose exposure and the risk of peritoneal dialysis associated peritonitis(PDAP).Methods In this single-center retrospective cohort study,patients who were treated with regular PD in the First Affiliated Hospital of Zhengzhou University PD center from January 1,2015 to December 31,2018 were recruited.Statistical analysis was conducted on demographic characteristics as well as clinical and biochemical data.According to the median glucose exposure at 6 weeks,6 months and 12 months after the initial treatment of peritoneal dialysis,the patients were divided into the high glucose exposure group and the low glucose exposure group.Cox proportional hazard model was used to analyze the relationship between glucose exposure and the risk of peritonitis.Chi-square test was used to analyze the difference in PDAP incidence between patients with high and low glucose exposure.Kaplan-Meier survival analysis was used to compare the time-to-peritonitis of high and low glucose exposure groups.Results A total of 227 patients were enrolled in our study.During a median 21(14,33)months follow up period,56 patients developed a peritonitis.The Cox univariate regression analysis at 6 weeks showed that glucose exposure was an independent risk factor of PDAP(HR=1.929,95%CI 1.033~3.600,P=0.039).After adjusting for covariates,including age,hemoglobin,blood sugar,total cholesterol and ferritin,the Cox multivariate regression analysis at 6 weeks showed that glucose exposure was still the independent risk factor of PDAP(HR=2.165,95%CI 1.066~4.397,P=0.033).Chi-square analysis showed that patients with high glucose exposure had a higher incidence of PDAP at 6 weeks(χ^(2)=6.480,P=0.011).Kaplan-Meier survival analysis showed that,compared to the patients with low glucose exposure,the patients with high glucose exposure at 6 weeks and 6 months had first PDAP earlier[(Log-rankχ^(2)=10.180,P=0.001)and(Log-rankχ^(2)=3.992,P=0.046)].Conclusion Patients with high glucose exposure in early peritoneal di

关 键 词：葡萄糖暴露量 腹膜透析 腹膜炎 危险因素 

分 类 号：R459.5[医药卫生—治疗学]