上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

腹透患者透出液癌抗原125水平变化与患者预后的关系

陈琪婕,方炜,严豪,倪兆慧,钱家麒   

  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:2016-03-28 发布日期:2017-06-02
  • 通讯作者: 方炜, 电子信箱: fangwei＿sh@126.com。
  • 作者简介:陈琪婕(1981—)， 女， 主治医师, 硕士生; 电子信箱: cicilumiere99@hotmail.com。

Correlation between changes in cancer antibody 125 level in dialysate and prognosis in peritoneal dialysis patients

CHEN Qi-jie, FANG Wei, YAN Hao, NI Zhao-hui, QIAN Jia-qi   

  1. Renal Division, Shanghai Center for Peritoneal Dialysis Research, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2016-03-28 Published:2017-06-02

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摘要：

目的 探讨腹膜透析（腹透）患者透出液中癌抗原125(CA125)水平变化对患者预后的影响。方法 入选2005年1月—2009年12月间在上海交通大学医学院附属仁济医院腹透中心行持续性非卧床腹透且透析12个月以上的资料完整的患者。入选患者在开始腹透时测定透出液中CA125(dCA125)浓度，腹透12个月后复测dCA125;根据dCA125变化的中位数，将患者分为dCA125稳定组和dCA125升高组;所有患者随访至死亡、退出腹透、转其他中心、失访或至研究终止日期(2014年6月30日)。采用KaplanMeier法比较两组患者生存率、技术生存率以及无腹膜炎生存时间，采用Cox比例风险模型分析与患者预后相关的独立危险因素。结果 共有111例患者入选本研究，平均年龄(535±147)岁，男性患者53例(477%)，27例(243%)患者合并糖尿病。两组患者的基线人口学资料、临床指标等差异均无统计学意义。研究期间，dCA125稳定组(n=55)患者共发生73次腹膜炎，平均腹膜炎发生率为1次/500病人月；dCA125升高组(n=56)患者共发生44次腹膜炎，平均腹膜炎发生率为1次/753病人月。dCA125稳定组患者的无腹膜炎生存时间明显短于dCA125升高组患者(logrank 6133，P=0013)。两组患者的长期生存率 (logrank 2108, P=0147)和技术生存率(logrank 0108, P=0743)差异均无统计学意义。Cox比例风险模型分析显示:dCA125升高(HR 0538，95%CI 0296~0979，P=003)是患者发生腹膜炎的独立保护因素。结论 腹透患者dCA125升高是发生腹膜炎的保护因素，而dCA125的变化与患者长期生存率、技术生存率无关。检测dCA125水平的变化可能可预测腹透患者腹膜炎的发生。

关键词: 腹膜透析, 癌抗原125, 腹膜炎, 危险因素

Abstract:

Objective To investigate the effects of changes in cancer antibody 125 (dCA125) level in dialysate from peritoneal dialysis (PD) patients on the prognosis. Methods Patients undergoing continuous ambulatory PD for more than 12 months in PD Center of Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 1, 2005 to December 31, 2009 and with complete data were enrolled. dCA125 levels in dialysate from enrolled patients were measured at the beginning of PD and after 12 months of PD. Patients were assigned to stable dCA125 group and elevated dCA125 group according to the median of dCA125 level changes. All patients were followed up until death, quitting PD, transferring to other centers, lost contact or study termination date (June 30, 2014). KaplanMeier method was used to compare survival, technique survival and peritonitisfree survival time between two groups. Cox proportional hazards model was used to analyze independent risk factors related to the prognosis of patients. Results A total of 111 patients were enrolled with 53 males (477%), a mean age of (535±147) years and 27 diabetic patients (24.3%). The differences in baseline demographics and clinical indexes between two groups were not statistically significant (P>005). Patients in the stable dCA125 group (n=55) developed 73 episodes of peritonitis and the mean incidence of peritonitis was 1/500 patient months. Patients in the elevated dCA125 group (n=56) developed 44 episodes of peritonitis and the mean incidence of peritonitis was 1/753 patient months. The peritonitisfree survival time in the stable dCA125 group was significantly shorter than that in the elevated dCA125 group (logrank 6133, P=0013). The differences in long term survival (logrank 2108, P=0147) and technique survival (logrank 0108, P=0743) between two groups were not statistically significant. Cox proportional hazards model analysis showed that elevated dCA125 level was an independent protective factor for peritonitis (HR 0538，95%CI 0296~0979，P=003). Conclusion Elevated dCA125 level in PD patients is a protective factor for peritonitis and changes in dCA125 level are unrelated to longterm survival and technique survival. Detection of changes in dCA125 level may predict the incidence of peritonitis in PD patients.

Key words: peritoneal dialysis, cancer antibody 125, peritonitis, risk factor