基于中医证型联合左室射血分数对腹膜透析患者预后的研究  

Study on Prognosis of Peritoneal Dialysis Patients Based on Chinese Medicine Syndrome Types Combined with Left Ventricular Ejection Fraction

作　　者：朱盛诚 何志仁[1,2] 王立新 ZHU Shengcheng;HE Zhiren;WANG Lixin(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou Guangdong 510006,China;Nephrology Department,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Chinese Medicine,Guangzhou Guangdong 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510006 [2]广州中医药大学第二附属医院/广东省中医院肾内科,广东广州510120

出　　处：《新中医》2024年第21期65-73,共9页New Chinese Medicine

基　　金：广东省中医院张大宁学术经验传承工作室(E43714中医二院〔2018〕102号)。

摘　　要：目的:回顾性分析不同中医证型的腹膜透析(PD)患者左室射血分数(LVEF),通过时间依赖性模型评估LVEF的动态变化对不同证型PD患者生存的影响。方法:收集不同证型的PD患者一般资料[性别、年龄、原发病、体质量指数(BMI)、共病指数(CCI)],实验室指标(所有的LVEF、首次透析治疗前尿酸、血红蛋白、红细胞沉降率、超敏C-反应蛋白、血尿素、血肌酐、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血清总蛋白、血清白蛋白、碱性磷酸酶、总胆红素等),结局事件(发生时间)等。使用多因素Cox回归筛选出影响生存率的因变量,再将这些因变量纳入时间依赖性Cox回归模型中,进一步研究动态变化的LVEF对不同证型PD患者预后的影响。结果:不同证型的PD患者的平均透析年龄、平均生存时间、性别比较,差异均有统计学意义(P<0.05)。脾肾阳虚组原发病为糖尿病肾病的比例高于脾肾气虚组和阴阳两虚组(P=0.022),且原发病为肾小球疾病的比例低于脾肾气虚组和阴阳两虚组(P=0.047)。脾肾阳虚组的剔除年龄后的共病指数值更高(P=0.002)。脾肾阳虚组在透析开始时左心室短轴缩短率和LVEF较低,总胆红素较高,差异有统计学意义(P<0.05)。对全部证型患者来说,年龄、性别、剔除年龄后的CCI评分为PD患者全因死亡的独立危险因素(P<0.05);原发病为肾小球疾病、高密度脂蛋白胆固醇为保护因素(P<0.05),且在脾肾气虚证中有统计学意义(P<0.05)。随着治疗的时间进程,LVEF每升高5%,PD患者的全因死亡率降低8%;在脾肾阳虚的PD患者中,LVEF每升高5%,全因死亡率降低11%。结论:PD患者以脾肾阳虚证为主,不同证型的PD患者在平均透析年龄、平均生存时间、性别上有差异,且LVEF的改善对全部证型的患者预后起保护作用,且在脾肾阳虚患者中保护作用更显著。Objective:To retrospectively analyze the left ventricular ejection fraction(LVEF)in peritoneal dialysis(PD)patients with different Chinese medicine syndrome types,and evaluate the impact of dynamic changes in LVEF on the survival of PD patients with different syndrome types through a time-dependent model.Methods:Collected general information[gender,age,primary disease,body mass indes(BMI),comorbidity index(CCI)],laboratory indicators(all LVEF,pre dialysis uric acid,hemoglobin,erythrocyte sedimentation rate,high-sensitivity C-reactive protein,blood urea,blood creatinine,triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,serum total protein,serum albumin,alkaline phosphatase,total bilirubin,etc.),and outcome events(occurrence time)of PD patients with different syndrome types.Used multiple factor Cox regression to screen for dependent variables that affect survival rate,and then incorporated these dependent variables into a time-dependent Cox regression model to further investigate the impact of dynamically changing LVEF on the prognosis of PD patients with different syndrome types.Results:The average dialysis age,average survival time,and gender comparison of PD patients with different syndrome types showed significant differences(P<0.05).The proportion of primary disease of the spleen kidney yang deficiency group as diabetes nephropathy was higher than that of the spleen kidney qi deficiency group and the deficiency of both yin and yang group(P=0.022),and the proportion of primary disease as glomerular disease was lower than that of spleen kidney qi deficiency group and deficiency of both yin and yang group(P=0.047).The comorbidity index of the spleen kidney yang deficiency group was higher after excluding age(P=0.002).The spleen kidney yang deficiency group had lower left ventricular short axis shortening rate and LVEF,and higher total bilirubin at the beginning of dialysis,with significant difference(P<0.05).For all syndrome types of patients,the age,gender,a

关 键 词：终末期肾病 腹膜透析 预后 中医证型 左心室射血分数 

分 类 号：R692.5[医药卫生—泌尿科学]