腹膜透析患者腹膜转运功能变化及其对心血管事件的影响  

Changes in peritoneal transport function and its influence on cardiovascular events in peritoneal dialysis patients

作　　者：闫奇奇 刘桂凌[1] 王瑞峰[1] 李丹丹[1] YAN Qi-qi;LIU Gui-ling;WANG Rui-feng;LI Dan-dan(Department of Nephrology,the Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《中国血液净化》2023年第5期335-338,共4页Chinese Journal of Blood Purification

基　　金：安徽医科大学第二附属医院临床研究培育计划重点项目(2021LCZD16)。

摘　　要：目的 探讨腹膜透析(peritoneal dialysis,PD)患者腹膜转运功能变化及其与心血管事件(cardiovascular events,CVE)的关系。方法 选取2014年1月1日~2019年12月31日于安徽医科大学第二附属医院腹膜透析置管后行PD的患者114例,随访至发生CVE、改为血液透析或肾移植、失访、死亡或研究终止日期(2021年12月31日)。根据4小时腹腔引流液肌酐与血浆肌酐比值(4hD/Pcr)变化分为增高组(70例)和降低组(44例)。比较2组患者CVE发生情况并采用COX回归探讨PD患者CVE的影响因素。结果 共44例(38.6%)患者发生CVE,其中增高组22例(31.4%),降低组22例(50%)。增高组累计无CVE比例高于降低组(χ~2=4.000,P=0.046)。多因素COX回归分析显示4hD/Pcr变化(HR=0.093,95%CI:0.013~0.662,P=0.018)和合并糖尿病(HR=2.824,95%CI:1.441~5.535,P=0.002)是PD患者发生CVE的独立影响因素。结论 4hD/Pcr降低的PD患者发生CVE的风险更高。Objective To investigate the changes in peritoneal transport function and its influence on car-diovascular events(CVE)in peritoneal dialysis(PD)patients.Method A total of 114 patients who started PD in the Second Hospital of Anhui Medical University from 1 January 2014 to 31 December 2019 were involved and followed until the occurrence of CVE,change to hemodialysis or kidney transplantation,loss to follow-up,death,or till the study termination date(31 December 2021).According to the changes in dialysate to plas-ma ratio of creatinine at 4h(4hD/Pcr),all participants were divided into increased(n=70)or decreased(n=44)groups.Compared the occurrence of CVE between the two groups and used the COX regression to explore the influencing factors of CVE in PD patients.Results In patients with baseline peritoneal transport func-tions were low transporters,4hD/Pcr tended to increase in the first two years,low average transporters in-creased in the first year,and both high and high average transporters showed a decreasing trend in the first two years.The patients in increased group were significantly younger than the decreased group(t=2.396,P=0.018).A total of 44(38.6%)patients developed CVE during a mean follow-up of 40.5 months.Among them,22(31.4%)were in the increase group and 22(50%)were in the decrease group.The cumulative proportion of CVE-free in the increased group was higher than that in the decreased group(χ^(2)=4.000,P=0.046).Multivari-ate Cox regression analysis showed that the changes in 4hD/Pcr(HR=0.093,95%CI:0.013~0.662,P=0.018)and diabetes mellitus(HR=2.824,95%CI:1.441~5.535,P=0.002)were independent influencing factors for the occurrence of CVE in PD patients.Conclusion PD patients with decreased 4hD/Pcr have a high risk of CVE.

关 键 词：腹膜透析 腹膜转运功能 4小时腹腔引流液与血浆肌酐比值 心血管事件 

分 类 号：R459.5[医药卫生—治疗学]