腹膜透析治疗终末期肾病合并肝硬化患者的临床疗效分析  

Clinical efficacy analysis of peritoneal dialysis in end⁃stage renal disease with cirrhotic patients

作　　者：李秋蕾 林琼真[1,2] 冉蕾 魏维[1] 张晓芳 闫雅茹 Li Qiulei;Lin Qiongzhen;Ran Lei;Wei Wei;Zhang Xiaofang;Yan Yaru(Department of Nephrology,the Third Affiliated Hospital of Hebei Medical University,Shijiazhuang,050051,China;Department of Nephrology,the First Affiliated Hospital of Hebei Medical University,Shijiazhuang 050030,China)

机构地区：[1]河北医科大学第三医院肾内科,石家庄050051 [2]河北医科大学第一医院肾内科,石家庄050030

出　　处：《中华肾脏病杂志》2022年第7期605-612,共8页Chinese Journal of Nephrology

摘　　要：目的探讨腹膜透析(peritoneal dialysis,PD)治疗终末期肾病合并肝硬化(liver cirrhosis,LC)的有效性和安全性。方法回顾性收集2013年1月1日至2020年3月31日在河北医科大学第三医院PD中心接受规律治疗且随访时间≥6个月、年龄≥18岁PD患者的临床资料。依据患者是否合并LC分为LC⁃PD组和非LC⁃PD组,采用倾向性评分匹配法进行1∶4匹配,比较两组患者基线临床资料、透析充分性、腹膜炎发生率和临床转归等方面的差异。采用Kaplan⁃Meier生存曲线和Log⁃rank检验比较两组患者生存率和技术生存率的差异。结果共241例PD患者入选本研究,倾向性评分匹配后纳入LC⁃PD组13例,非LC⁃PD组52例。与非LC⁃PD组比较,LC⁃PD组患者基线尿量较少(Z=-3.546,P<0.001)、基线血清白蛋白较低(Z=-2.609,P=0.009)。随访3、6、12、24个月时,LC⁃PD组患者血清总蛋白(t=-3.319,P=0.002)、血清白蛋白(t=-4.019,P<0.001)、三酰甘油(Z=-2.263,P=0.024)和血磷(Z=-2.173,P=0.030)水平均低于非LC⁃PD组。至随访第2年,LC⁃PD组患者血清白蛋白较基线值显著升高(χ^(2)=16.901,P=0.001),两组血清白蛋白水平的差异无统计学意义(χ^(2)=0.155,P=0.694)。LC⁃PD组患者残肾尿素清除指数(Kt/V)下降速率慢于非LC⁃PD组(χ^(2)=44.589,P<0.001)。LC⁃PD组患者PD相关性腹膜炎发生率显著高于非LC⁃PD组(0.59/患者年比0.20/患者年,Z=-2.135,P=0.033)。两组患者病原菌构成均以革兰阳性菌为主(10/25例次比11/30例次),LC⁃PD组链球菌占比高于非LC⁃PD组(4/10比0/11,P=0.035),首次腹膜炎大肠埃希菌感染比例高于非LC⁃PD组(4/9比1/22,P=0.017)。Kaplan⁃Meier生存曲线结果显示,两组患者的生存率(Log⁃rankχ^(2)=0.491,P=0.484)及技术生存率(Log⁃rankχ^(2)=0.408,P=0.523)的差异均无统计学意义。结论PD治疗终末期肾病合并LC安全、有效,LC⁃PD患者生存率和技术生存率与非LC⁃PD患者相当。本透析中心LC⁃PD患者腹膜炎�Objective To investigate the efficacy and safety of peritoneal dialysis(PD)in end⁃stage renal disease(ESRD)patients with liver cirrhosis(LC).Methods Clinical data of PD patients receiving regular treatment followed up for≥6 months,and aged≥18 years in the Third Affiliated Hospital of Hebei Medical University Peritoneal Dialysis Center from January 1,2013 to March 31,2020 were retrospectively collected.The patients were divided into LC⁃PD group and non⁃LC⁃PD group according to whether they had LC or not.Propensity score matching(PSM)was used to match the LC⁃PD group and the non⁃LC⁃PD group with 1∶4 ratio.The baseline clinical data,dialysis adequacy,peritonitis and clinical outcomes between the two groups were compared.Kaplan⁃Meier survival curve and Log⁃rank test were used to compare the survival rate and technical survival rate between the two groups.Results A total of 241 PD patients were included in this study.After PSM,13 cases in LC⁃PD group and 52 cases in non⁃LC⁃PD group were included.Compared with non⁃LC⁃PD group,patients in LC⁃PD group had lower baseline urine volume(Z=-3.546,P<0.001)and serum albumin(Z=-2.609,P=0.009).At the follow⁃up of 3,6,12 and 24 months,total serum protein(t=-3.319,P=0.002),serum albumin(t=-4.019,P<0.001),triglyceride(Z=-2.263,P=0.024),and serum phosphorus(Z=-2.173,P=0.030)in the LC⁃PD group were lower than those in non⁃LC⁃PD group.During the follow⁃up period of 2 years,the patients in the LC⁃PD group had significantly higher serum albumin than baseline values(χ^(2)=16.901,P=0.001),and there was no statistically significant difference between the two groups(χ^(2)=0.155,P=0.694).The decline rate of residual kidney Kt/V in the LC⁃PD group was slower than that in the non⁃LC⁃PD group(χ^(2)=44.589,P<0.001).The incidence of peritonitis in LC⁃PD group was higher than that in the non⁃LC⁃PD group,with a statistically significant difference(0.59/patient⁃year vs 0.20/patient⁃year,Z=-2.135,P=0.033).The composition ratio of patho

关 键 词：肝硬化 腹膜透析 腹膜炎 终末期肾病 

分 类 号：R692.5[医药卫生—泌尿科学] R575.2[医药卫生—外科学]