纳入血清胱抑素C的非糖尿病腹膜透析患者技术生存率列线图建立及验证  

Establishment and validation of the Nomogram incorporating serum cystatin C for the technical survival of non-diabetic peritoneal dialysis patients

作　　者：张锁建[1] 蔡小琴[1] 叶慧 李海涛[1] ZHANG Suo-jian;CAI Xiao-qin;YE Hui;LI Hai-tao(Department of Nephrology,Taixing People's Hospital,Taizhou 225400,China)

机构地区：[1]泰兴市人民医院肾内科,泰州225400

出　　处：《中国血液净化》2022年第7期473-477,共5页Chinese Journal of Blood Purification

基　　金：泰兴市人民医院院级课题(try2101);江苏大学临床医学科技发展基金项目(JLY2021193);蚌埠医学院科技项目(2020byzd272)。

摘　　要：目的探索建立纳入血清胱抑素C的非糖尿病腹膜透析(peritoneal dialysis,PD)患者技术生存率列线图,并进行验证。方法收集2010年1月~2019年1月在泰兴市人民医院新进入PD治疗的非糖尿病患者,收集患者的一般人口学资料和实验室指标;开始规律PD治疗后1个月计算尿素清除指数(urea clearance index,Kt/V)和4h时PD液/血液肌酐比值(4h dialysate to plasma creatinine ratio,4h D/PCr)。记录患者第1年中发生腹膜炎次数。采用COX回归分析PD患者退出的危险因素。纳入有意义指标,使用R语言绘制列线图,个体化预测PD患者1、3、5年技术生存率的情况,并采用校准曲线图、Harrell一致性指数(concordance index,C-index)进一步验证列线图预测PD患者技术生存率的准确性。结果共163名患者入组,男性90名(55.21%),女性73名(44.78%),平均年龄(48.75±13.23)岁。血清胱抑素C值为(5.56±1.08)mg/L。单因素COX分析显示:较高的血清胱抑素C(HR=1.275,95%CI:1.031~1.577,P=0.026)、男性(HR=0.582,95%CI:0.350~0.968,P=0.037)、第1年发生腹膜炎次数(HR=1.564,95%CI:1.002~2.440,P=0.049)、较高的4h D/PCr(HR=1.217,95%CI:0.967~1.531,P=0.095)是PD治疗失败的危险因素,较高的血清白蛋白(HR=0.928,95%CI:0.876~0.982,P=0.010)、残余肾功能(residual renal function,RRF)Kt/V(HR=0.174,95%CI:0.078~0.388,P<0.001)和总Kt/V(HR=0.276,95%CI:0.137~0.554,P<0.001)是PD治疗技术存活的保护因素。因RRF Kt/V和总Kt/V与血清胱抑素C存在共线性,故未纳入COX多因素回归。多因素COX回归模型发现,校正性别、第1年发生腹膜炎次数、血清白蛋白、4h D/PCr后,较高的血清胱抑素C是PD治疗失败的独立危险因素(HR=1.288,95%CI:1.032~1.603,P=0.025)。绘制的纳入血清胱抑素C的列线图预测PD患者的技术生存率C-index为0.712(95%CI:0.652~0.772),校准曲线图显示预后列线图模型和实际观察值之间一致性较好。结论透析前较高的血清胱抑素C水平的非糖尿病PD患者技术生存Objective To establish and verify a Nomogram incorporating serum cystatin C for the technical survival of non-diabetic peritoneal dialysis(PD)patients.Methods We included non-diabetic patients who newly admitted to PD treatment in our Hospital between January 2010 to January 2019.Demographic and biochemical data were collected.Urea clearance index and 4h dialysate to plasma creatinine ratio(4h D/PCr)were recorded 1 month after starting regular PD treatment.Episodes of peritonitis in the first year of PD were also recorded.Risk factors for end-point events were analyzed by Cox regression model.The Nomogram was used to evaluate the prediction of the 1,3 and 5-year technical survival rate of PD patients by meaningful indicators.The calibration curve and Harrell concordance index(C-index)were used to verify the accuracy of the Nomogram in predicting the technical survival rates of PD patients.Results We enrolled 163 patients,including 90 males(55.21%)and 73 females(44.78%),with an average age of(48.75±13.23)years.The serum cystatin C level was(5.56±1.08)mg/L.Univariate Cox regression showed that higher serum cystatin C(HR=1.275,95%CI:1.031~1.577,P=0.026),male(HR=0.582,95%CI:0.350~0.968,P=0.037),peritonitis episodes in the first year(HR=1.564,95%CI:1.002~2.440,P=0.049),and higher 4h D/PCr(HR=1.217,95%CI:0.967~1.531,P=0.095)were risk factors for PD failure,while higher serum albumin(HR=0.928,95%CI:0.876~0.982,P=0.010),residual renal function(RRF),urea clearance index(Kt/V)(HR=0.174,95%CI:0.078~0.388,P<0.001)and total Kt/V(HR=0.276,95%CI:0.137~0.554,P<0.001)were protective factors for PD technical survival.Because serum cystatin C had a collinearity with RRF Kt/V and total Kt/V,the Kt/V measurements were excluded.After incorporating the covariates with P<0.1 into a multivariate Cox regression,serum cystatin C was an independent risk factor for PD failure(HR=1.288,95%CI:1.032~1.603,P=0.025).The C-index of Nomogram predicting the technical survival rate of PD patients was 0.712(95%CI:0.652~0.772).The calibration curve a

关 键 词：胱抑素C 列线图 腹膜透析 

分 类 号：R459.5[医药卫生—治疗学]