糖尿病腹膜透析患者合并腹膜炎的预后分析及血清白蛋白变化特征  

Prognostic analysis and characteristics of serum albumin changes in diabetic peritoneal dialysis patients complicated with peritonitis

作　　者：喇晓霞 马亚琪 王丽[1,3] 王永春 田娜[1,3] LA Xiaoxia;MA Yaqi;WANG Li;WANG Yongchun;TIAN Na(Department of Nephrology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Shuofang Road Community Health Service Center,Yinchuan 750021,China;Ningxia Nephrology Clinical Research Center,Yinchuan 750021,China)

机构地区：[1]宁夏医科大学总医院肾脏内科,宁夏银川750004 [2]银川市西夏区朔方路社区卫生服务中心,宁夏银川750021 [3]宁夏肾脏病临床研究中心,宁夏银川750004

出　　处：《宁夏医学杂志》2024年第7期603-606,共4页Ningxia Medical Journal

基　　金：宁夏回族自治区重点研发项目(2022BEG03120)。

摘　　要：目的对比糖尿病(DM)与非糖尿病(NDM)合并腹膜透析相关性腹膜炎(PDAP)患者的临床疗效、转归及PDAP发生前后血清白蛋白变化情况。方法本研究采用回顾性队列研究,纳入408例确诊为PDAP的患者,根据患者是否合并DM,分为DM组和NDM组。DM组116例,平均年龄(60.04±10.06)岁,透析龄32.00(12.00,53.00)月;NDM组292例,平均年龄(52.36±14.40)岁,透析龄36.96(15.96,63.00)月。对比2组患者的临床特征、临床疗效、转归及PDAP发生前后血清白蛋白变化情况及影响因素。结果与NDM组相比,DM组患者年龄明显较大,男性比例较高(P<0.05)。同时,DM组患者血肌酐、血钙、尿素、白蛋白均低于NDM组(P<0.05)。临床疗效分析中,DM组患者中复发、再发、重现的发生率较NDM组高,但组间差异无明显统计学意义(P>0.05)。与NDM组相比,DM组患者治愈率较低,治疗结束后技术生存率、死亡率较高(P<0.05);2组患者生存率分析中,DM组患者的生存率显著低于NDM组患者(P<0.05)。血清白蛋白变化分析中,2组患者在腹膜炎前后血清白蛋白状况均显著下降,相较于NDM组患者,DM组患者的血清白蛋白水平状况在腹膜炎前后均更差(P<0.05)。DM组患者中的性别、血红蛋白、血钾、血肌酐、血钙等对血清白蛋白的影响具有独立影响因素(P<0.05)。结论相比NDM组,DM组患者年龄明显较大,复发、再发、重现的发生率较高,治愈率较低,而治疗结束后技术生存率、死亡率较高。生存曲线分析中,DM组患者的生存率显著低于NDM组患者。血清白蛋白水平在DM和NDM患者中在腹膜炎前后均显著下降,而DM组患者腹膜炎发生前后白蛋白水平更低(P<0.05)。影响DM合并腹膜炎患者血清白蛋白水平的因素包括性别、血红蛋白、血钾、血肌酐、尿素、血钙等,其中性别、血红蛋白、血钾、血肌酐、血钙等是血清白蛋白水平的独立影响因素。Objective To compare the clinical efficacy and the changes of serum albumin before and after PDAP in patients with diabetes mellitus(DM)and non-diabetes mellitus(NDM)combined with peritoneal dialysis-related peritonitis(PDAP).Methods A retrospective cohort study was conducted.408 patients with PDAP were selected,who were divided into DM and NDM groups.There were 116 patients in the DM group,with an average age of(60.04±10.06)years and a dialysis age of 32.00(12.00,53.00)months.There were 292 patients in the NDM group,with an average age of(52.36±14.40)years and a dialysis age of 36.96(15.96,63.00)months.The clinical characteristics,clinical efficacy,outcome and the changes in serum albumin and the influencing factors before and after the occurrence of PDAP were followed up and compared between the two groups.Results Compared with the NDM group,the patients in the DM group was significantly older and a higher proportion of males(P<0.05).Meanwhile,the levels of creatinine,calcium,urea and albumin in the DM group were lower than those in the NDM group(P<0.05).The incidence of recurrence was higher in DM group than that in NDM group,but there was no significant difference between the two groups(P>0.05).Compared with NDM group,the patients in DM group had lower cure rate,and higher technical survival rate and mortality rate after treatment(P<0.05).The survival rate of patients in the DM group was significantly lower than those in the NDM group(P<0.05).The serum albumin status in both groups decreased significantly before and after peritonitis(P<0.05).The gender,hemoglobin,potassium,creatinine and calcium in DM group had independent influencing factors on the serum albumin(P<0.05).Conclusion The prognosis of diabetic peritoneal dialysis patients complicated with peritonitis is relatively poor.The serum albumin level decreases more significantly than that in the non-diabetic patient.

关 键 词：腹膜透析 腹膜炎 糖尿病 治疗转归 白蛋白水平 

分 类 号：R692.5[医药卫生—泌尿科学]