不同原发病的腹膜透析患者预后相关研究进展  

Progress of the Differen Primary Disease on the Prognosis in Patients with Peritoneal Dialysis

作　　者：徐静燕 徐梅 王艳[2] 田娜 XU Jingyan;XU Mei;WANG Yan;TIAN Na(First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of Nephrology,General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学第一临床医学院,银川750004 [2]宁夏医科大学总医院肾脏内科,宁夏医科大学第一临床医学院,银川7500042

出　　处：《宁夏医科大学学报》2024年第4期422-427,共6页Journal of Ningxia Medical University

基　　金：宁夏回族自治区重点研发项目(2022BEG03120)。

摘　　要：腹膜透析(PD)是肾脏替代治疗的重要手段,接受PD的患者约占全球透析人口的11%。很少有文献总结不同原发病类型与腹膜透析患者预后的关系。原发病为肾小球肾炎的PD患者预后优于糖尿病肾病、高血压肾病等所致的PD患者。在原发肾小球病中,IgA肾病患者较其他肾小球肾炎患者的并发症更少,病死率更低。糖尿病是公认的PD预后不良的风险因素,包括腹膜炎、PD技术失败和病死率。与一般高血压患者类似,PD患者血压和总病死率之间存在U型曲线关系,血压高与动脉粥样硬化和心血管并发症的风险密切相关,但PD期间低血压同样会导致不良预后。多数研究认为,接受PD治疗的多囊肾病患者可能出现更多的腹壁疝和腹膜渗漏,从而导致透析不足、技术失败、疝气或渗漏。但是,近年的一些研究认为,多囊肾病患者预后和技术生存率与非多囊肾病患者相似。既往多项研究表明,接受PD的系统性红斑狼疮(SLE)患者预后较非SLE患者差,因为他们的腹膜炎以及其他感染的发生率更高,但部分长队列研究也证明,对于SLE患者,PD是一种安全且同样成功的治疗方法。Peritoneal dialysis(PD)is an important means of renal replacement therapy,which is used by around 11%of dialysis patients worldwide.There is a dearth of literature summarizing the correlation between various primary disease types and peritoneal dialysis patients’prognosis.Patients whose primary disease is glomerulonephritis have a better prognosis than those whose nephropathy is caused by diabetes or hypertension.IgA nephropathy patients among primary glomerulopathies had fewer complications and lower mortality rate than patients with other glomerulonephritis.Diabetes is a recognized risk factor for poor prognosis in PD,including peritonitis,PD technical failure,and mortality.There is a U-shaped curve link between blood pressure and overall mortality in PD patients,similar to that in general hypertension individuals.High blood pressure is closely related to the risk of atherosclerosis and cardiovascular complications,but low blood pressure during PD can also lead to adverse outcomes.According to the majority of research,patients with polycystic kidney disease who receive PD may develop more abdominal hernias and peritoneal effusion,which could lead to insufficient dialysis,technical failure,hernias,or effusion.However,according to certain studies published recently,patients with polycystic kidney disease have a similar prognosis and technical survival rate as patients without the condition.Many prior studies have demonstrated that systemic lupus erythematosus(SLE)patients receiving PD have a worse prognosis than non-SLE patients due to their higher incidence of peritonitis and other infections.However,some long-cohort studies have also demonstrated that PD is a safe and effective treatment option for SLE patients.

关 键 词：腹膜透析 原发病 糖尿病肾病 多囊肾 预后 

分 类 号：R692.5[医药卫生—泌尿科学]