腹膜透析患者初始腹膜高转运与置管前控制营养状态评分的关系  

Relationship between initial high peritoneal solute transport and score of baseline controlling nutritional status in patients undergoing peritoneal dialysis

作　　者：张丽洁 马爽 仵远远 蒲薪羽 丁芮 李争艳 肖静 赵占正 ZHANG Lijie;MA Shuang;WU Yuanyuan;PU Xinyu;DING Rui;LI Zhengyan;XIAO Jing;ZHAO Zhanzheng(Kidney Disease Hospital,the First Af filiated Hospital of Zhengzhou University,Institute of Kidney Disease of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院肾脏病医院,郑州大学肾脏病研究所,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2023年第11期1106-1110,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划项目(2018020104);郑州大学第一附属医院科研创新团队项目(ZYCXTD2023009)。

摘　　要：目的观察腹膜透析(PD)患者置管前控制营养状态(CONUT)评分情况,探讨其与PD患者初始腹膜高转运的关系。方法2014年1月—2020年12月郑州大学第一附属医院行持续性非卧床PD患者465例,均初次行PD置管术,根据置管前CONUT评分分为高CONUT评分组(CONUT评分≥5分)177例和低CONUT评分组(CONUT评分<5分)288例。2组PD开始后每1~3个月行1次腹膜平衡试验,记录第1次腹膜平衡试验4h透析液肌酐/血肌酐比值。比较2组血压、血清铁蛋白等临床资料及腹膜初始转运状态;采用Spearman相关性分析PD患者置管前CONUT评分与临床指标的相关性;采用多因素logistic回归分析PD患者初始腹膜高转运的影响因素。结果高CONUT评分组男性比率(69.5%)、舒张压[(90.53±14.15)mmHg]、血清铁蛋白[282.60(133.15,465.90)μg/L]、4h透析液肌酐/血肌酐比值[0.76(0.67,0.87)]、CONUT评分[6.00(5.00,7.00)分]、初始腹膜高转运比率(35.6%)均高于低CONUT评分组[60.0%、(87.78±13.55)mmHg、222.45(105.88,397.35)μg/L、0.69(0.59,0.77)、3.00(2.00,4.00)分、15.6%](P<0.05),白细胞计数[5.20(4.39,6.50)×109/L]、淋巴细胞计数[0.82(0.64,1.07)×109/L]、血小板计数[145(106,197)×109/L]、血红蛋白[(79.74±17.20)g/L]、血白蛋白[(33.52±5.08)g/L]、总胆固醇[(3.47±0.95)mmol/L]、三酰甘油[1.07(0.83,1.40)mmol/L]、血尿酸[437.00(345.00,524.50)μmol/L]、尿量[1200(925,1800)mL/24h]均低于低CONUT评分组[5.94(4.90,7.00)×109/L、1.21(0.93,1.50)×109/L、176(144,220)×109/L、(88.49±19.45)g/L、(38.58±4.00)g/L、(4.23±1.12)mmol/L、1.39(0.97,1.90)mmol/L、468.00(390.00,575.50)μmol/L、1500(1000,2000)mL/24h](P<0.05)。PD患者置管前CONUT评分与舒张压、血肌酐、铁蛋白、4h透析液肌酐/血肌酐比值均呈正相关(P<0.05),与白细胞计数、淋巴细胞计数、血小板计数、血红蛋白、血白蛋白、总胆固醇、三酰甘油、血尿酸、尿量均呈负相关(P<0.05)。性别(OR=2.209,95%CI:1.314~3.713,P=0.003)、舒张�Objective To observe the score of baseline controlling nutritional status(CONUT)in patients with peritoneal dialysis(PD),and to explore its relationship with initial high peritoneal solute transport.Methods Totally465 patients undergoing continuous ambulatory PD received initial PD catheterization in the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020,According to the baseline CONUT score,465 patients were divided into 177 patients with CONUT score≥5(high CONUT group)and 288 patients with CONUT score<5(low CONUT group).Both two groups underwent a peritoneal homeostasis test every 1 to 3 months after the start of PD,and the first 4-h peritoneal dialysate/plasma creatinine ratio(D/PCr)was recorded.The baseline clinical data including blood pressure and serum ferritin as well as peritoneal solute transport status were compared between two groups.Spearman correlation analysis was performed to analyze the correlation between baseline CONUT score and clinical parameters.Multivariate logistic analysis was done to assess the influencing factors of initial high peritoneal solute transport in PD patients.Results The male ratio,diastolic blood pressure,serum ferritin,4-h D/PCr,CONUT score and high peritoneal solute transport rate were higher in high CO NUT group[69.5%,(90.53±14.15)mmHg,282.60(133.15,465.90)μg/L,0.76(0.67,0.87),6.00(5.00,7.00),35.6%]than those in low CONUT group[60.0%,(87.78±13.55)mmHg,222.45(105.88,397.35)μg/L,0.69(0.59,0.77),3.00(2.00,4.00),15.6%](P<0.05),the blood white cell count,lymphocyte,platelet,hemoglobin,serum albumin,total cholesterol,triacylglycerol,serum uric acid and urine volume were lower in high CONUT group[5.20(4.39,6.50)×10~9/L,0.82(0.64,1.07)×109/L,145(106,197)×10~9/L,(79.74±17.20)g/L,(33.52±5.08)g/L,(3.47±0.95)mmol/L,1.07(0.83,1.40)mmol/L,437.00(345.00,524.50)μmol/L,200(925,1800)mL/24 h]than those in low CONUT group[5,94(4.90,7.00)×10~9/L,1.21(0.93,1.50)×10~9/L,176(144,220)×10~9/L(88.49±19.45)g/L,(38.58±4.00)g/L,(4.23±1.12)mmol/L,1.

关 键 词：腹膜透析 控制营养状态评分 腹膜高转运 

分 类 号：R692.5[医药卫生—泌尿科学]