初次腹膜透析患者腹膜高转运特性的危险因素  

Risk factors of high peritoneal transport characteristics in initial peritoneal dialysis patients

作　　者：唐静[1,2] 付平[1] 钟慧[1] TANG Jing;FU Ping;ZHONG Hui(Division of Nephrology,Kidney Research Institute,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Division of Nephrology,Pan gang Group General Hospital,Panzhihua,Sichuan 617000,P.R.China)

机构地区：[1]四川大学华西医院肾脏内科,成都610041 [2]攀钢集团总医院肾脏内科,四川攀枝花617000

出　　处：《华西医学》2021年第11期1556-1562,共7页West China Medical Journal

摘　　要：目的探讨初次持续非卧床腹膜透析的终末期肾病患者腹膜高转运特性的危险因素。方法回顾性收集2011年1月-2017年12月在四川大学华西医院肾脏内科初次行腹膜透析置管并完成了腹膜平衡试验的持续非卧床腹膜透析患者的临床资料。根据标准腹膜透析平衡试验的4 h腹膜透析液与血肌酐的比值[dialysate to plasma ratio for creatinine at 4 hour,D/Pcr(4h)],将患者分为4组(低转运组、低平均转运组、高平均转运组、高转运组)。采用Spearman秩相关分析等方法分析D/Pcr(4h)的相关因素,有序多分类logistic回归分析探讨腹膜高转运特性的危险因素。结果共纳入患者647例,平均年龄为(45.85±14.03)岁,平均D/Pcr(4h)为0.67±0.12;其中,高转运组89例(13.76%),高平均转运组280例(43.28%),低平均转运组234例(36.17%),低转运组44例(6.80%)。糖尿病者D/Pcr(4h)高于非糖尿病者(0.72±0.12 vs. 0.66±0.12;t=-4.005,P<0.001)。相关分析显示年龄、24 h尿量与D/Pcr(4h)呈正相关;血清白蛋白、甘油三酯、钾、钙、镁、磷、血红蛋白、血清尿酸和肌酐与D/Pcr(4h)呈负相关;体表面积(body surface area,BSA)、高敏C反应蛋白、铁蛋白、胆固醇、钠、全段甲状旁腺激素、估算肾小球滤过率与D/Pcr(4h)无相关关系。回归分析显示患者血清白蛋白[比值比(odds ratio,OR)=0.842,95%置信区间(confidence interval,CI)(0.809,0.877),P<0.001]、血清尿酸[OR=0.996,95%CI(0.994,0.998),P<0.001]、镁[OR=0.389,95%CI(0.156,0.965),P=0.042]、BSA[OR=3.916,95%CI(1.121,13.680),P=0.032]与患者腹膜高转运特性发生率有相关性。结论低血清白蛋白、高BSA、低血清尿酸和低镁是初始腹膜透析患者高转运特性的独立危险因素。Objective To investigate the risk factors of high peritoneal transport characteristics in patients with end-stage renal disease undergoing initial continuous ambulatory peritoneal dialysis. Method The clinical data of continuous ambulatory peritoneal dialysis patients who underwent initial peritoneal dialysis and catheterization in the Department of Nephrology, West China Hospital of Sichuan University from January 2011 to December 2017 and completed the peritoneal equilibration test were collected retrospectively. According to the ratio of dialysate to plasma ratio for creatinine at 4 hour [D/Pcr(4 h)] in the standard peritoneal equilibration test, the patients were divided into4 groups(low transport, low average transport, high average transport and high transport). Spearman correlation analysis was used to analyze the related factors of D/Pcr(4 h). The risk factors of high peritoneal transport characteristics were analyzed by ordered multi classification logistic regression. Results A total of 647 patients were included. The average age of the patients was(45.85±14.03) years, and the average D/Pcr(4 h) was 0.67±0.12. Among them, there were 89 cases(13.76%) in the high transport group, 280 cases(43.28%) in the high average transport group, 234 cases(36.17%) in the low average transport group and 44 cases(6.80%) in the low transport group. Diabetic patients with D/Pcr(4 h) were higher than those without diabetes mellitus(0.72±0.12 vs. 0.66±0.12;t=-4.005, P<0.001). Correlation analysis showed that age and 24-h urine volume were positively correlated with D/Pcr(4 h);serum albumin, triglyceride, potassium, calcium,magnesium, phosphorus, hemoglobin, serum uric acid and creatinine were negatively correlated with D/Pcr(4 h);body surface area(BSA), high sensitivity C-reactive protein, ferritin, cholesterol, sodium, intact parathyroid hormone and estimated giomerular filtration rate had no correlation with D/Pcr(4 h). Regression analysis showed that serum albumin[odds ratio(OR)=0.842, 95% confidence interval(CI)(0.8

关 键 词：初次腹膜透析 腹膜高转运 体表面积 血清白蛋白 尿酸 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]