TyG、CRP/Alb、25(OH)D与维持性腹膜透析患者预后的关联性  

The relationship between TyG,CRP/Alb,25(OH)D and the prognosis of patients with continous ambulatory peritoneal dialysis

作　　者：李洋[1] 王亚芬 李相[1] 骆纳纳 焦占峰[1] 马小芬[1] 袁良东[1] 张士奇[1] 张宜明[1] Li Yang;Wang Yafen;Li Xiang;Luo Nana;Jiao Zhanfeng;Ma Xiaofen;Yuan Liangdong;Zhang Shiqi;Zhang Yiming(Department of Nephrology,Affiliated Hospital of Jining Medical College,Jining 272000,China)

机构地区：[1]济宁医学院附属医院肾内科,济宁272000

出　　处：《中国医师杂志》2022年第9期1335-1339,共5页Journal of Chinese Physician

基　　金：山东省中医药科技发展计划项目(2019-0484)。

摘　　要：目的探讨甘油三酯葡糖乘积指数(TyG)、C反应蛋白与白蛋白比值(CRP/Alb)、25-羟基维生素D[25(OH)D]与维持性腹膜透析(CAPD)患者预后的关联性。方法前瞻性选取济宁医学院附属医院2017年1月至2020年3月收治的220例CAPD患者,根据6个月预后情况分为死亡组、生存组。比较两组腹膜尿素清除指数(Kt/V_(urea))、TyG、CRP/Alb、25(OH)D水平。采用logistic回归分析CAPD患者预后的影响因素。采用受试者工作特征(ROC)曲线分析TyG、CRP/Alb、25(OH)D对CAPD患者预后的预测价值。结果死亡组透析3、6个月后腹膜Kt/V_(urea)[(1.21±0.18)ml/(s·1.73 m^(2))、(1.02±0.14)ml/(s·1.73 m^(2))]显著低于生存组[(1.57±0.40)ml/(s·1.73 m^(2))、(1.49±0.42)ml/(s·1.73 m^(2))](均P<0.05)。死亡组透析3、6个月后TyG[(8.79±0.86)、(9.24±1.03)]、CRP/Alb[(4.98±0.94)×10^(-4)、(5.14±1.39)×10^(-4)]高于生存组[(8.03±0.60)、(7.26±0.93)、(3.57±1.19)×10^(-4)、(3.07±0.88)×10^(-4)],25(OH)D[(19.14±2.29)ng/ml、(17.79±3.17)ng/ml]低于生存组[(22.67±3.03)ng/ml、(24.31±2.51)ng/ml](均P<0.05)。透析3、6个月后的TyG、CRP/Alb与Kt/V_(urea)均呈负相关,25(OH)D与Kt/V_(urea)均呈正相关(均P<0.05);logistic回归分析显示,透析3、6个月后的Kt/V_(urea)、TyG、CRP/Alb、25(OH)D均与预后相关(均P<0.05)。透析6个月后TyG、CRP/Alb、25(OH)D联合预测CAPD患者预后的AUC最大,为0.911。结论TyG、CRP/Alb、25(OH)D与CAPD患者全因死亡相关,高TyG、CRP/Alb,低25(OH)D提示全因死亡风险更高,各指标联合检测可有效预测CAPD预后,便于早期进行临床干预。Objective To investigate the relationship between triglyceride glucos(TyG),C-reaction protein/albumin(CRP/Alb),25-hydroxy vitamin D[25(OH)D]and the prognosis of patients with continous ambulatory peritoneal dialysis(CAPD).Methods A total of 220 CAPD patients in the Affiliated Hospital of Jining Medical University from January 2017 to March 2020 were prospectively selected and divided into death group and survival group according to the 6-month prognosis.The peritoneal urea clearance index(Kt/V_(urea)),TyG,CRP/Alb,25(OH)D were compared between the two groups.Logistic regression was used to analyze the prognostic factors of CAPD patients.The predictive value of TyG,CRP/Alb and 25(OH)D on the prognosis of CAPD patients was analyzed by receiver operating characteristic(ROC)curve.Results After 3 months and 6 months of dialysis,the peritoneal Kt/V_(urea) in the death group[(1.21±0.18)ml/(s·1.73 m^(2)),(1.02±0.14)ml/(s·1.73 m^(2))]was significantly lower than that in the survival group[(1.57±0.40)ml/(s·1.73 m^(2)),(1.49±0.42)ml/(s·1.73 m^(2))](all P<0.05).After 3 months and 6 months of dialysis,the TyG[(8.79±0.86),(9.24±1.03)]and CRP/Alb[(4.98±0.94)×10^(-4),(5.14±1.39)×10^(-4)]in the death group were higher than those in the survival group[(8.03±0.60),(7.26±0.93),(3.57±1.19)×10^(-4),(3.07±0.88)×10^(-4)],while the 25(OH)D[(19.14±2.29)ng/ml,(17.79±3.17)ng/ml]was lower than that of survival group[(22.67±3.03)ng/ml,(24.31±2.51)ng/ml](all P<0.05).TyG and CRP/Alb at 3 months and 6 months of dialysis were negatively correlated with Kt/V_(urea),while the 25(OH)D was positively correlated with Kt/V_(urea)(all P<0.05).Logistic regression analysis showed that Kt/V_(urea),TyG,CRP/Alb and 25(OH)D were associated with prognosis in the two groups after 3 and 6 months of dialysis(all P<0.05).The AUC of TyG,CRP/Alb and 25(OH)D at 6 months of dialysis combined to predict the prognosis of CAPD patients was the highest,which was 0.911.Conclusions TyG,CRP/Alb and 25(OH)D are associated with all-cause mortality in CAP

关 键 词：腹膜透析 持续不卧床 甘油三酯葡糖乘积指数 C反应蛋白 白蛋白 25-羟基维生素D 尿素清除指数 

分 类 号：R692.5[医药卫生—泌尿科学]