维持性腹膜透析患者低血白蛋白水平及持续时间对新发腹膜透析相关性腹膜炎影响的多中心研究  

A multi⁃center study on effect of low serum albumin levels and duration on first episode of peritonitis in continuous ambulatory peritoneal dialysis

作　　者：谭艳红 陈进忠 钟少鑫 罗绮媚 潘健怡 艾军[3] 孔耀中[4] 霍志濠 窦献蕊 Tan Yanhong;Chen Jinzhong;Zhong Shaoxin;Luo Qimei;Pan Jianyi;Ai Jun;Kong Yaozhong;Huo Zhihao;Dou Xianrui(Guangdong Medical University,Zhanjiang 524000,China;Department of Nephrology,Shunde Hospital,Southern Medical University(the First People's Hospital of Shunde),Foshan 528308,China;Department of Nephrology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Nephrology,the First People′s Hospital of Foshan,Foshan 528000,China)

机构地区：[1]广东医科大学,湛江524000 [2]南方医科大学顺德医院(佛山市顺德区第一人民医院)肾病科,佛山528308 [3]南方医科大学南方医院肾内科,广州510515 [4]佛山市第一人民医院肾内科,佛山528000

出　　处：《中华肾脏病杂志》2022年第7期597-604,共8页Chinese Journal of Nephrology

基　　金：佛山市科学技术局项目(2020001005230)。

摘　　要：目的探讨维持性腹膜透析(peritoneal dialysis,PD)患者低血白蛋白(serum albumin,ALB)水平及其持续时间与新发PD相关性腹膜炎的关系。方法回顾性选择2000年9月1日至2021年7月6日在珠三角地区南方医科大学顺德医院、南方医科大学南方医院及佛山市第一人民医院PD中心定期随访的PD患者,根据患者ALB均值分为低血白蛋白(low serum albumin,LSA)组(ALB均值<35 g/L)、中血白蛋白(moderate serum albumin,MSA)组(35 g/L≤ALB均值<40 g/L组)和高血白蛋白(high serum albumin,HSA)组(ALB均值≥40 g/L),比较3组临床资料的差异。使用Kaplan⁃Meier生存分析法比较不同ALB均值组腹膜炎事件的发生风险。采用多因素Cox回归模型分析血ALB水平及低白蛋白血症持续时间与新发腹膜炎的相关关系。结果本研究共纳入1853例PD患者,年龄(49.72±15.34)岁,男性1036例(55.9%),LSA组患者551例(29.7%),MSA组患者920例(49.7%),HSA组患者382例(20.6%)。中位随访37(15,66)个月,新发腹膜炎患者508例(27.4%)。与LSA组相比,MSA组及HSA组新发腹膜炎发生率较低(χ^(2)=14.053,P<0.001;χ^(2)=21.857,P<0.001),而HSA与MSA两组新发腹膜炎发生率的差异无统计学意义。Kaplan⁃Meier生存分析结果提示,LSA组患者腹膜炎累积发生率较MSA组及HSA组患者明显升高(Log⁃rankχ^(2)=22.128,P<0.001)。与正常血ALB的PD患者相比,低白蛋白血症持续时间越长的PD患者新发腹膜炎发生率有升高趋势。多因素Cox回归分析结果提示,ALB均值<35 g/L(LSA组/MSA组,HR=1.495,95%CI 1.198~1.866,P<0.001;LSA组/HSA组,HR=1.459,95%CI 1.104~1.928,P=0.008)是PD患者新发腹膜炎的独立危险因素;且随着低白蛋白血症持续时间延长,PD患者新发腹膜炎的风险显著升高(HR=1.013,95%CI 1.003~1.024,P=0.014)。结论ALB均值<35 g/L和低白蛋白血症持续时间延长是PD患者PD相关性腹膜炎发生的独立危险因素。Objective To explore the relationship between low serum albumin levels and its duration on first episode of peritonitis in peritoneal dialysis(PD)patients.Methods PD patients who were regularly followed up in the Pearl River Delta region from September 1,2000 to July 6,2021 in Shunde Hospital of Southern Medical University,Nanfang Hospital of Southern Medical University,and Foshan First People′s Hospital were retrospectively selected.The patients were divided into low serum albumin group(LSA group,mean albumin<35 g/L),moderate serum albumin group(MSA group,35 g/L≤mean albumin<40 g/L)and high serum albumin group(HSA group,mean albumin≥40 g/L)according to the mean albumin of the patients,and the differences among the three groups were compared.The Kaplan⁃Meier survival analysis method was used to compare the risk of peritonitis events in different mean albumin groups and different durations of hypoalbuminemia.The multivariate Cox regression model was used to analyze the relationship between serum albumin levels and duration of hypoalbuminemia and new⁃onset peritonitis.Results A total of 1853 PD patients were included in this study,aged(49.72±15.34)years,and 1036(55.9%)males.There were 551 patients(29.7%)in the LSA group,920 patients(49.7%)in the MSA group,and 382 patients(20.6%)in the HSA group.The median follow⁃up was 37(15,66)months and there were 508 patients(27.4%)with new⁃onset peritonitis during the follow⁃up.Compared with the LSA group,the incidence of new peritonitis in the MSA group and HSA group was lower(χ^(2)=14.053,P<0.001;χ^(2)=21.857,P<0.001),but there was no significant difference in the incidence of new peritonitis between the HSA group and MSA group.The Kaplan⁃Meier survival analysis showed that the cumulative incidence of peritonitis in the LSA group was significantly higher than that in the MSA group and HSA group(Log⁃rankχ^(2)=22.128,P<0.001).Compared with PD patients with normal serum albumin,the patients with longer duration of hypoalbuminemia tended to have a higher i

关 键 词：腹膜透析 腹膜炎 血清白蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]