腹膜透析相关性腹膜炎痊愈后营养不良-炎症-动脉粥样硬化综合征对患者临床不良预后的影响  

Effect of malnutrition-inflammation-atherosclerosis(MIA)syndrome on clinical adverse prognosis among patients with peritoneal dialysis associated peritonitis after recovery

作　　者：乔雨萌 徐潇 董捷[1] QIAO Yu-meng;XU Xiao;DONG Jie(Renal Division,Peking University First Hospital,Institute of Nephrology,Peking University,Key Laboratory of Renal Disease,Ministry of Health of China,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、北京大学肾脏疾病研究所、卫生部肾脏疾病重点实验室、中国医学科学院免疫介导肾病诊治创新单元,北京100034

出　　处：《中国血液净化》2023年第5期349-354,共6页Chinese Journal of Blood Purification

摘　　要：目的探讨腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis,PDAP)痊愈后营养不良-炎症-动脉粥样硬化(malnutrition,inflammation and atherosclerosis,MIA)综合征对腹膜透析(以下简称腹透)患者临床不良预后的影响。方法回顾性分析2008年01月01日~2021年12月31日在北京大学第一医院腹透中心发生PDAP并痊愈腹透患者的临床资料。结合患者是否合并心血管疾病、腹膜炎痊愈后3个月内血白蛋白<35g/L以及C反应蛋白(CRP)>3mg/L,将患者分为MIA=0(全否)、MIA=1(1项为是)和MIA≥2(≥2项为是)组。以MIA=0为参考组,采用多因素COX比例风险模型及竞争风险模型分析MIA分值是否为腹膜炎患者预后不良(死亡、转血液透析及腹膜炎再发)的预测因素。结果研究期间共有483例患者发生716次腹膜炎,其中397例(82.19%)患者首次腹膜炎痊愈后继续维持腹透,剔除数据缺失的96例患者,本研究最终共纳入301例患者,其中MIA=0组患者74例(24.58%),MIA=1患者112例(37.21%),MIA≥2组115例(38.21%)。腹膜炎痊愈后MIA分值越高的患者在基线时白蛋白水平越低(F=26.306,P<0.001),CRP水平越高(F=8.549,P=0.014)。采用COX比例风险模型分析,发现与腹膜炎痊愈后MIA=0的患者相比,MIA=1分及MIA≥2分的患者死亡风险分别增加了137%(HR=2.369,95%CI:1.127~4.979;P=0.023)和448%(HR=5.480,95%CI:2.590~11.590;P<0.001)。通过竞争风险模型发现MIA分值对增加患者转血液透析和腹膜炎再发的风险无显著影响。结论PDAP痊愈后MIA综合征对患者产生持续影响,存在MIA综合征因素越多死亡风险越高。Objective To investigate the effect of malnutrition-inflammation-atherosclerosis(MIA)syn-drome on the poor prognosis of patients with peritoneal dialysis associated peritonitis(PDAP)after recovery.Methods Clinical data of the patients developed PDAP and then cured in the Peritoneal Dialysis Center of Pe-king University First Hospital between January 1,2008 and December 31,2021 were retrospectively ana-lyzed.These patients were divided into MIA0,MIA1 and MIA≥2 groups according to whether or not they had cardiovascular disease,serum albumin<35g/L or C-reactive protein(CRP)>3mg/L within 3 months after recovery from PDAP.With MIA0 group as the reference,multivariate COX proportional risk model and com-petitive risk model were used to analyze whether MIA score was a predictor of death,transferred to hemodial-ysis,and recurrent peritonitis.Results During the study period,a total of 716 PDAP episodes occurred in 483 patients,of which 397(82.19%)patients continued to maintain PD after recovery from the first PDAP.Ex-cluding 96 patients with missing data,301 patients were finally incorporated in this study,including 74 pa-tients(24.58%)in MIA0 group,112 patients(37.21%)in MIA1 group,and 115 patients(38.21%)in MIA≥2 group.The results suggested that the patients with higher MIA score had lower albumin level and higher CRP level at baseline(P<0.05).COX proportional risk model found that death risks of the patients in MIA1 and MIA≥2 groups increased by 137%(HR 2.369,95%CI:1.127~4.979,P=0.023)and 448%(HR 5.480,95%CI:2.590~11.590,P<0.001),respectively,as compared with that of the patients in MIA0 group.The competitive risk model showed that MIA score had no significant effects on the risks of transferred to hemodialysis and re-current peritonitis.Conclusion MIA syndrome has a continuous adverse effect on patients after recovery from PDAP.The more the items of MIA syndrome,the higher the risk of mortality in the PDAP patients after recovery.

关 键 词：腹膜透析相关性腹膜炎 炎症状态 营养不良 心血管疾病 预后 

分 类 号：R459.5[医药卫生—治疗学]