上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (8): 1090-.doi: 10.3969/j.issn.1674-8115.2017.08.008

• 论著（基础研究） • 上一篇    下一篇

腹膜透析患者初始高腹膜转运状态危险因素分析

林涛1*，余戈平2*，谢静远1，黄晓敏1，徐天1，王丽1,3，李晓1，张春燕1，徐耀文1，任红1，陈楠1   

  1. 1. 上海交通大学 医学院附属瑞金医院肾脏科，肾脏病研究所，上海 200025；2. 上海交通大学 医学院附属瑞金医院桐庐分院，桐庐县第一人民 医院肾脏科，桐庐 311500；3. 上海市杨浦区市东医院肾脏科，上海  200438
  • 出版日期:2017-08-28 发布日期:2017-09-28
  • 通讯作者: 陈楠，电子信箱：cnrj100@126.com
  • 作者简介:?林涛（1979—），男，主治医师，硕士生；电子信箱：23430851@qq.com。余戈平（1972—），女，主任医师；电子信箱：hztiz66@126.com。* 为共 同第一作者
  • 基金资助:
    国家重点研发计划项目（2016YFC0904100）；国家自然科学基金（81570598，81370015）；国家卫计委临床重点专科；浙江省医药卫生科技计划项 目（2015KYB336）；上海市教育委员会高峰高原学科建设计划（20152207）；上海市科委国际合作交流项目（14430721000）；上海交通大学医学院多中心临床研 究项目（DLY201510）；上海市重中之重学科建设专项资助

Risk factors analysis of initial high peritoneal solute transport status in peritoneal dialysis patients

LIN Tao1*, YU Ge-ping2*, XIE Jing-yuan1, HUANG Xiao-min1, XU Tian1, WANG Li1, 3, LI Xiao1, ZHANG Chun-yan1, XU Yao-wen1, REN Hong1, CHEN Nan1   

  1. 1. Department of Nephrology, Ruijin Hospital, Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 2. Department of Nephrology, Tonglu Hospital Affiliated to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Tonglu 311500, China; 3. Department of Nephrology, Shidong Hospital of Shanghai Yangpu District, Shanghai 200438, China
  • Online:2017-08-28 Published:2017-09-28
  • Supported by:
    National Key Research and Development Program of China, 2016YFC0904100; National Natural Science Foundation of China, 81570598, 81370015; National Key Clinical Specialist Construction Programs of China; Medical Science and Technology Project of Zhejiang Province, 2015KYB336; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152207; International Cooperation and Exchange Project of Shanghai Science and Technology Commitee, 14430721000; Multicenter Clinical Research Program of Shanghai Jiao Tong University School of Medicine, DLY201510; Key Clinical Disciplines Construction Grant Support, Shanghai Municipal Health and Family Commission

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摘要：  目的 · 探讨不同转运状态的新入腹膜透析（PD）患者的临床特点，对腹膜高转运状态的危险因素进行分析。方法 · 对 2007 年 1 月—2015 年 10 月连续新入 PD 患者（455 例）的临床资料进行回顾性分析。根据患者首次标准腹膜平衡实验（sPET）结果参考 ISPD 指南将患者分为H/HA 组（4h D/Pcr ≥ 0.65）与L/LA 组（4h D/Pcr<0.65），比较2 组临床及生化参数的差异；建立Logistic 回 归模型，分析高腹膜转运状态的危险因素。结果 · 共入选372 例新入PD 患者，L/LA 组和H/HA 组患者分别为264 例（71.2%）和 108 例（28.8%）。相比 L/LA 组患者，H/HA 组男性患者比例较高（63.0% vs 50.8%，P=0.03），残余肾功能较低［（4.26±2.77） mL/min
 vs （5.79±4.53） mL/min，P<0.01）］，血清白蛋白水平较低［（29.34±6.89） g/L vs (32.08±5.86) g/L，P=0.00］，糖尿病肾病比例较高 （19.4% vs 9.5%，P=0.00）。 Logistic 回归分析结果显示：低白蛋白血症（OR=0.96，95% CI 0.28 ～ 0.99；P=0.02），男性（OR=1.92，
 95% CI 1.19 ～ 3.12；P=0.00），糖尿病肾病（OR=2.52，95% CI 1.26 ～ 5.05；P=0.00）及低残肾功能（OR=0.90，95% CI 0.83 ～ 0.96；
 P=0.00）是腹膜高转运状态的危险因素。进一步分析发现，与正常血白蛋白组相比，低血白蛋白组患者高敏C 反应蛋白（hsCRP） 水平更高（1.69 mg/L vs 0.69 mg/L，P=0.00）。 结论 · 纳入患者初始腹透时以低及低平均转运状态为主。低白蛋白血症、男性、糖尿 病肾病及低残余肾功能是腹膜高转运状态的危险因素。慢性炎症状态可能部分解释了PD 患者低白蛋白血症与腹膜高转运状态的相 关性。

关键词: 腹膜溶质转运, 危险因素, 腹膜透析, 低白蛋白血症, 残余肾功能

Abstract:

Objective · To investigate the clinical characteristics of initial peritoneal dialysis (PD) patients with different peritoneal transport status, and analyze risk factors of high peritoneal transport status in PD patients.  Methods · A total of 455 consecutive PD patients newly starting PD between January 2007 to October 2015 were retrospectively analyzed. According to the results of the first sPET, patients were divided into H/HA (4h D/Pcr≥0.65) and L/ LA (4h D/Pcr<0.65) groups. Clinical and biochemical characteristics between the two groups were compared. Multivariate logistic regression model was established to investigate risk factors of higher peritoneal transport status of incident PD patients.  Results · The study included 372 incident PD patients. The L/LA group and H/HA group had 264 cases (71.2%) and 108 cases (28.8%) respectively. The H/HA group had higher proportion of male patients (63.0% vs 50.8%, P=0.03), lower residual renal function [RRF, (4.26±2.77) mL/min vs (5.79±4.53) mL/min, P<0.01], lower serum albumin level [(29.34±6.89) g/L vs (32.08±5.86) g/L, P=0.00], and more frequent diabetic nephropathy (19.4% vs 9.5%, P=0.00), compared with L/LA group. Univariate and multivariate logistic regression analysis showed that higher peritoneal transport status was associated with lower serum albumin level (OR=0.96, 95% CI 0.28-0.99; P=0.02), male (OR=1.92, 95% CI 1.19-3.12; P=0.00), presence of diabetic nephropathy (OR=2.52, 95% CI 1.26-5.05; P=0.00) and lower residual renal function (OR=0.90, 95% CI 0.83-0.96; P=0.00). The level of hsCRP in patients with hypoalbuminemia was higher than that in patients with normal albumin level (1.69 mg/L vs 0.69 mg/L, P=0.00).  Conclusion · Low and low average peritoneal transport status accounted for the majority of the patients in this study. Low serum albumin levels, male, diabetic nephropathy, RRF were risk factors of initial high peritoneal solute transport status. Chronic inflammatory status might partially explain for the correlation between hypoalbuminemia and high peritoneal solute transport status in PD patients.

Key words:  peritoneal solute transport, risk factor, peritoneal dialysis, hypoalbuminemia, residual renal function