维持性腹膜透析患者透析龄的预后因素分析  

Prognostic factors of dialysis age in patients with maintenance peritoneal dialysis

作　　者：梁如练 温跃强[3] 汪年松 吴险峰[1,2] LIANG Ru-lian;WEN Yue-qiang;WANG Nian-song;WU Xian-feng(Department of Nephrology,Shanghai Eighth People’s Hospital,Shanghai 200030,China;Department of Nephrology,Shanghai Sixth People’s Hospital,Shanghai 200030,China;Department of Nephrology,Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]上海市第八人民医院肾内科,上海200030 [2]上海市第六人民医院肾内科,上海200030 [3]广州医科大学附属第二医院肾内科,广州510260

出　　处：《中国血液净化》2024年第12期901-905,919,共6页Chinese Journal of Blood Purification

摘　　要：目的分析维持性腹膜透析患者透析龄的预后相关因素。方法回顾性分析常青藤肾脏病联盟(evergreen tree nephrology association,ETNA)腹膜透析数据库2005年11月─2020年5月诊治的571例成人维持性腹膜透析患者临床资料,计算生存率、技术生存率,分析影响患者预后因素。腹膜透析(peritoneal dialysis,PD)患者根据透析龄分为长透析龄组(≥60月),短透析龄组(<60月),分析2组患者预后及影响透析龄的危险因素。结果571例PD患者1、2、3、5、10年累积生存率为94%、88.8%、80.9%、70.3%、49.8%,累积技术生存率分别为94%、88.8%、80.8%、69.3%、39.2%。多因素COX回归分析显示:慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)病史(HR=3.339,95%CI:1.054~10.576,P=0.040)、低密度脂蛋白升高(HR=1.222,95%CI:1.032~1.447,P=0.020)、肺部感染(HR=1.568,95%CI:1.252~1.965,P<0.001)是PD患者死亡的独立危险因素。Logistic回归分析显示:吸烟(OR=0.349,95%CI:0.139~0.873,P=0.024)、全段甲状旁腺激素(iPTH)升高(OR=0.999,95%CI:0.998~1.000,P=0.048)、尿量少(OR=1.001,95%CI:1.000~1.001,P<0.001)是影响透析龄的独立危险因素。结论吸烟、iPTH升高、尿量少是影响透析龄的独立危险因素,戒烟、合理降低iPTH、保护残余肾功能可延长患者透析时间。Objective The prognostic factors of dialysis vintage in patients on maintenance peritoneal dialysis were analyzed.Methods The clinical data of 571 patients on maintenance peritoneal dialysis(PD)in Evergreen Tree Nephrology Association(ETNA)Peritoneal dialysis database from November 2005 to May 2020 were analyzed retrospectively.The survival rate and technical survival rate were calculated,and the risk factors influencing prognosis were analyzed.PD patients were divided into long dialysis vintage group(≥60 months)and short dialysis vintage group(<60 months),and the prognosis of the patients in different dialysis vintage groups and the risk factors affecting dialysis vintage were analyzed.Results The 1-,2-,3-,5-and 10-year cumulative survival rates of the 571 PD patients were 94%,88.8%,80.9%,70.3%and 49.8%.The cumulative technical survival rates were 94%,88.8%,80.8%,69.3%and 39.2%,respectively.COX Multivariate regression analysis showed that chronic obstructive pulmonary disease(COPD)history(HR=3.39,95%CI:1.054~10.576,P=0.040),elevated Low-Density lipoprotein cholesterol(LDL-c)(HR=1.222,95%CI:1.032~1.447,P=0.020)and pulmonary infection(HR=1.568,95%CI:1.252~1.965,P<0.001)were independent risk factors of death in PD patients(P<0.05).Logistic regression analysis showed that Smoking(OR=0.349,95%CI:0.139~0.873,P=0.024),elevated intact parathyroid hormone(iPTH)(OR=0.999,95%CI:0.998~1.000,P=0.048)and low urine volume(OR=1.001,95%CI:1.000~1.001,P<0.001)were independent risk factors of technical failure.Conclusion Smoking,elevated iPTH and low urine volume are independent risk factors of technical failure.Smoking cessation,rational reduction of iPTH and protection of residual renal function can prolong patients'dialysis vintage.

关 键 词：腹膜透析 生存分析 技术生存率 危险因素 透析龄 

分 类 号：R459.5[医药卫生—治疗学]