基于腹膜转运功能探讨的腹膜透析患者远期预后  

Effect of peritoneal transport function on long-term prognosis of peritoneal dialysis patients

作　　者：刘莹 张庆燕 蒋春明[1] 孙琤[1] 徐鹏飞 张苗[1] LIU Ying;ZHANG Qing-yan;JIANG Chun-ming;SUN Cheng;XU Peng-fei;ZHANG Miao(Department of Nephrology,Nanjing Drum Tower Hospital,Clinical College of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学鼓楼临床医学院(南京鼓楼医院)肾内科,南京210000

出　　处：《中国血液净化》2022年第5期331-335,共5页Chinese Journal of Blood Purification

基　　金：南京鼓楼医院临床研究专项(2021-LCYJ-PY-12)。

摘　　要：目的回顾性分析不同基线腹膜转运功能的腹膜透析(peritoneal dialysis,PD)患者的临床特点、预后以及腹膜转运功能变化,探讨腹膜转运功能对PD患者预后的影响。方法选取2006年1月1日~2019年12月30日在南京医科大学鼓楼临床医学院肾内科开始PD治疗且维持性PD≥3月的患者。根据腹膜透析液与血清的肌酐比值(dialysate/plasma creatinine,D/Pcr)进行腹膜转运功能分组,比较不同组的基线资料和预后以及腹膜转运功能的变化趋势。结果共323例患者纳入本研究,其中低转运组70例,低平均转运组135例,高平均转运组101例,高转运组17例。Logistic回归显示:男性(OR=1.529,95%CI:1.003~2.330,P=0.049)和低白蛋白血症(OR=0.910,95%CI:0.869~0.952,P<0.001)是基线腹膜高转运状态的决定因素。高转运组患者累计生存率低于低转运组(χ^(2)=3.953,P=0.047)、低平均转运组(χ^(2)=4.355,P=0.037)、高平均转运组(χ^(2)=9.359,P=0.002);技术生存率各组间差异无统计学意义(χ^(2)=0.107,P=0.991)。平均D/Pcr值在前5年保持稳定,第5年之后有轻微升高趋势。各组间腹膜转运状态随时间呈现向心性改变趋势,即高转运组下降,低转运组升高。COX多因素回归分析显示:年龄(OR=1.053,95%CI:1.026~1.082,P<0.001)、查尔森合并症指数(Charlson’s comorbidity index,CCI)(OR=1.630,95%CI:1.307~2.032,P<0.001)和基线腹膜高转运状态(OR=3.280,95%CI:1.109~9.699,P=0.032)是患者全因死亡的独立危险因素;男性(OR=1.851,95%CI:1.123~3.052,P=0.016)、C反应蛋白(OR=1.008,95%CI:1.001~1.015,P=0.025)和腹膜炎(OR=2.312,95%CI:1.430~3.739,P<0.001)是技术失败的独立危险因素。结论基线腹膜高转运状态是影响患者生存率的独立危险因素,而男性和低蛋白血症是基线腹膜高转运的重要决定因素。腹膜转运功能在透析前5年保持稳定,随后逐渐升高,不同腹膜转运功能随PD时间延长呈现向心性趋势,即高转运组下降,低转运组升高。Objective To evaluate the effects of baseline and changes of peritoneal transport characteristics on the prognosis of peritoneal dialysis(PD)patients.Methods Patients who started PD in the period from January 1,2006 to December 30,2019 and continued PD for more than 3 months in the Department of Nephrology of Nanjing Drum Tower Hospital were included in this study.They were divided into 4 groups according to the baseline dialysate/plasma creatinine(D/Pcr)ratio.Their clinical characteristics,trends of peritoneal transport changes,risk factors for death,and technique failure were analyzed.Results A total of 323 PD patients were enrolled in this study,including 70 patients in low transport(L)group,135 in low average transport(LA)group,101 in high average transport(HA)group,and 17 in high transport(H)group.Multinomial logistic regression model revealed that male(OR=1.529,95%CI 1.003~2.330,P=0.049)and low albumin(OR=0.910,95%CI 0.869~0.952,P<0.001)were the risk factors for baseline high peritoneal transport status.The survival rate in H group was significantly lower than that in L group(χ^(2)=3.953,P=0.047),LA group(χ^(2)=4.355,P=0.037)and HA group(χ^(2)=9.359,P=0.002).There was no significant difference in technique survival rate among the four groups(χ^(2)=0.107,P=0.991).The D/Pcr ratio remained stable in the first 5 years and then presented a slight upward trend.The peritoneal transport status of the four groups had a tendency of centrality with time,i.e.,peritoneal transport decreased in higher transport groups and increased in lower transport groups.Multivariate Cox regression analyses showed that age(OR=1.053,95%CI 1.026~1.082,P<0.001),Charlson’s comorbidity index(OR=1.630,95%CI 1.307~2.032,P<0.001)and baseline high transport(OR=3.280,95%CI 1.109~9.699,P=0.032)were the independent risk factors for all-cause mortality,and male(OR=1.851,95%CI 1.123~3.052,P=0.016),C-reactive protein(OR=1.008,95%CI 1.001~1.015,P=0.025)and peritonitis(OR=2.312,95%CI 1.430~3.739,P<0.001)were the independent risk factors for tech

关 键 词：腹膜透析 预后 腹膜转运特性 

分 类 号：R459.5[医药卫生—治疗学]