腹膜透析患者腹内压与临床症状的相关性分析  

Association of intraperitoneal pressure and clinical symptoms in peritoneal dialysis patients

作　　者：郝佳玉 阿比囡扎 许莹[1] 马甜甜 董捷[1] Hao Jiayu;A Bi'nanzha;Xu Ying;Ma Tiantian;Dong Jie(Renal Division,Peking University First Hospital,Institute of Nephrology,Peking University,Key Laboratory of Renal Disease,Ministry of Health of China,Key Laboratory of Chronic Kidney Disease Prevention and Treatment(Peking University),Ministry of Education,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases,Chinese Academy of Medical Sciences,Beijing 100034,China)

机构地区：[1]北京大学第一医院肾内科、北京大学肾脏病研究所、卫健委重点实验室、教育部慢性肾脏病防治重点实验室、中国医学科学院免疫介导肾病诊治创新单元,北京100034

出　　处：《中华肾脏病杂志》2023年第5期345-352,共8页Chinese Journal of Nephrology

摘　　要：目的探究腹膜透析患者腹内压与临床症状的相关性。方法横断面研究,根据入选和排除标准纳入2021年1月1日至10月31日在北京大学第一医院接受腹膜透析的患者,以腹内压测量金标准——Durand法测定灌入2 L透析液后的腹内压,收集患者临床和实验室资料。按照腹内压≥18 cmH2O与否将入选者分为腹内压升高组和腹内压正常组。采用自行设计的半定量问卷调查患者腹胀、胃胀、反酸、打嗝和胸闷或憋气等5种临床症状的程度和频度,以及放空腹膜透析液后症状的缓解程度。采用Pearson相关或Spearman相关分析法分析各变量与腹内压的相关性。结果共194例腹膜透析患者入选该研究,年龄(51.6±12.9)岁,男性123例(63.4%),女性71例(36.6%),合并糖尿病60例(30.9%),中位透析龄24.0(10.0,54.0)个月,腹内压(16.2±4.3)cmH2O,腹内压升高70例(36.1%)。相关性分析结果显示,腹内压与体重(r=0.23,P<0.001)、体重指数(r=0.41,P<0.001)、体表面积(r=0.15,P=0.030)、三酰甘油(r=0.22,P=0.001)和超敏C反应蛋白(r=0.20,P<0.001)水平均呈正相关,与合并糖尿病(r=-0.14,P=0.034)和血钙(r=-0.15,P=0.034)水平均呈负相关。腹内压与5种临床症状频度总分值之间无显著相关性(r=0.122,P=0.092)。腹内压升高组患者胃胀频度高于腹内压正常组(P=0.002),两组患者在胃胀程度和放空透析液后症状缓解程度的差异均无统计学意义(均P>0.05)。两组患者在其余4项临床症状的程度、频度及放空透析液后症状缓解程度等方面的差异均无统计学意义(均P>0.05)。结论腹内压升高与临床症状关联度不大,提示仅根据患者主观感受调整透析液灌入量并不可靠,需常规监测腹内压。Objective To explore the association between the intraperitoneal pressure(IPP)and clinical symptoms in peritoneal dialysis(PD)patients.Methods It was a cross-sectional study.PD patients of Peking University First Hospital from January 1,to October 31,2021,were enrolled according to the inclusion and exclusion criterion.The gold standard—Durand method was used to measure the IPP of PD patients for 2 L intraperitoneal volume,and clinical and laboratory data were collected.According to whether the IPP≥18 cmH2O or not,the participants were divided into elevated IPP group and normal IPP group.A self-designed semi-quantitative questionnaire was used to investigate the frequency and degree of five clinical symptoms,including abdominal distension,bloating,acid reflux,hiccup and chest tightness or suffrage,as well as the degree of symptom relief after emptying peritoneal dialysate.Pearson or Spearman correlation analysis was used to analyze the correlation between each variable and intraperitoneal pressure.Results A total of 194 PD patients were enrolled,with age of(51.6±12.9)years old.Of them,there were 123 males(63.4%),71 females(36.6%)and 60 patients(30.9%)with diabetes.The median dialysis vintage was 24.0(10.0,54.0)months.The IPP was(16.2±4.3)cmH2O,and 70(36.1%)patients had elevated IPP.Correlation analysis results showed that IPP was positively correlated with body weight(r=0.23,P<0.001),body mass index(r=0.41,P<0.001),body surface area(r=0.15,P=0.030),triglyceride(r=0.22,P=0.001),high-sensitivity C-reactive protein(r=0.20,P<0.001),and negatively correlated with diabetes(r=-0.14,P=0.034)and serum calcium(r=-0.15,P=0.034).There was no significant correlation between IPP and the total frequency score of five clinical symptoms(r=0.122,P=0.092).The frequency of stomach distension in elevated IPP group was significantly higher than that in normal IPP group(P=0.002),and there were no significant differences in the degree and relief degree of stomach distension between the two groups(all P>0.05).There were no statisti

关 键 词：腹膜透析 腹内压 数据相关性 临床症状 

分 类 号：R692.5[医药卫生—泌尿科学]