上海交通大学学报(医学版) ›› 2017, Vol. 37 ›› Issue (6): 786-.doi: 10.3969/j.issn.1674-8115.2017.06.013

• 论著(临床研究) • 上一篇    下一篇

腹膜透析患者容量负荷的相关影响因素研究

李峰,方炜,严豪,李振元,袁江姿,倪兆慧   

  1. 上海交通大学 医学院附属仁济医院肾脏科,上海市腹膜透析研究中心,上海  200127
  • 出版日期:2017-06-28 发布日期:2017-07-05
  • 通讯作者: 方炜,电子信箱:fangwei_sh@126.com
  • 作者简介:李峰(1982—),男,主治医师,硕士生;电子信箱 :415870280@qq.com
  • 基金资助:

    上海市教育委员会高峰高原学科建设计划(20152211);国家自然科学基金(81370864,81670691)

Study on the relevant factors affecting the hydration status in peritoneal dialysis patients

LI Feng, FANG Wei, YAN Hao, LI Zhen-yuan, YUAN Jiang-zi, NI Zhao-hui   

  1. Department of Nephrology, Shanghai Research Center for Peritoneal Dialysis, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2017-06-28 Published:2017-07-05
  • Supported by:

    Shanghai Municipal Education Commission— Gaofeng Clinical Medicine Grant Support,20152211;National Natural Science Foundation of China,81370864,81670691

摘要:

目的 · 探讨维持性腹膜透析患者容量负荷的相关影响因素。方法 · 选取2016 年 9 月至2017 年 1 月上海交通大学医学院附 属仁济医院的规律腹膜透析患者,采集患者的人口学资料,检测生化指标,评估患者的腹膜转运特性及透析充分性,应用多频生物 电阻抗技术测量患者容量超负荷指标overhydration(OH)值。采用多元线性回归分析OH 值的独立相关因素。结果 · 共入选147 例 患者,其中男性90 例(61.2%),年龄中位数为58.52 岁,透析龄中位数为43.03 个月,21 例(14.3%)患者合并糖尿病,容量超负 荷(OH>1.1 L)患者共 107 例(72.8%)。与正常容量负荷组(OH ≤ 1.1 L)患者相比,容量超负荷组患者的糖尿病比例、体表面积、 Charlson 合并症评分、血清脑钠肽 (BNP)水平、腹膜平衡试验结果 (4 h D/Pcr)、24 h 透出液蛋白均显著增高(均 P<0.05),而总尿素 清除率 (Kt/V)、血清白蛋白降低(均 P<0.05)。多元线性回归分析结果显示:合并糖尿病(P=0.000)、较高的 4 h D/Pcr(P=0.000)和 较低的血清白蛋白(P=0.001)是 OH 值升高的独立相关因素。结论 · 维持性腹膜透析患者普遍处于容量超负荷状态,合并糖尿病、高 4 h D/Pcr 和低血清白蛋白是容量超负荷的独立相关因素。

关键词: &ensp, 腹膜透析, 容量状态, 生物电阻抗

Abstract:

 Objective · To explore influencing factors associated with the hydration status in peritoneal dialysis (PD) patients.  Methods · Eligible PD patients treated in Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September 2016 to January 2017 were enrolled. Demographic data of patients were collected and biochemical indexes were measured. Their peritoneal transport characteristics and dialysis adequacy were evaluated. Hydration status index overhydration (OH) value was measured with bioimpedance spectroscopy. Multivariate linear regression was used to analyze the independent factors associated with the OH.  Results · A total of 147 PD patients with a median age of 58.52 years and a median PD duration of 43.03 months were enrolled. Of them, 90 (61.2%) were male, 21(14.3%) were accompanied by diabetes mellitus, and 107 (72.8%) were overhydrated (OH>1.1L). Compared to those with normal hydration status (OH ≤ 1.1 L), the overhydrated patients had higher proportion of diabetes,
 BSA, Charlson comorbidity score, brain natriuretic peptide (BNP), 4 h D/Pcr, and 24 h dialysate protein, and lower tKt/V, serum albumin than the normal hydrated patients (all P<0.05). Multivariate linear regression showed that comorbid diabetes mellitus (P=0.000), higher 4h D/Pcr (P=0.000), and lower serum albumin level (P=0.001) were independent relevant factors for the increase of OH.  Conclusion · Overhydration is common in PD patients. Comorbid diabetes mellitus, higher 4 h D/Pcr, and lower serum albumin are independent relevant factors for the hydration status in
 PD patients.

Key words:  peritoneal dialysis, overhydration, bioimpedance spectroscopy