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

炎症、营养不良、瓣膜钙化指标联合预测腹膜透析患者全因死亡和心血管死亡的价值

周艳， 方炜， 严豪， 袁江姿， 李振元， 俞赞喆， 黄佳颖， 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:2016-09-28 发布日期:2016-10-31
  • 通讯作者: 方炜， 电子信箱: fangwei_sh@126.com。
  • 作者简介:周艳（1980—）， 女， 主治医师， 硕士； 电子信箱: 11789191@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）；上海市科学技术委员会项目（114119a5900）

Value of combining inflammation, malnutrition, and calcification for predicting all-cause and cardiovascular mortality in peritoneal dialysis patients

ZHOU Yan, FANG Wei, YAN Hao, YUAN Jiang-zi, LI Zhen-yuan, YU Zan-zhe, HUANG Jia-ying, NI Zhao-hui, QIAN Jia-qi   

  1. Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Peritoneal Dialysis Research Center， Shanghai 200127, China
  • Online:2016-09-28 Published:2016-10-31
  • Supported by:

    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support， 20152211； Project of Shanghai Municipal Science and Technology Commission， 114119a5900

PDF (PC)

824

摘要：

目的·探讨联合应用炎症、营养不良和心脏瓣膜钙化指标是否能更好地对腹膜透析（简称腹透）患者的全因死亡和心血管死亡进行危险分层。方法·入选2011年3月—2013年8月在上海交通大学医学院附属仁济医院腹透中心稳定地进行规律腹透的患者，使用心脏多普勒超声诊断仪检测患者的心脏瓣膜钙化（CVC）情况。根据高敏C-反应蛋白（hs-CRP）、低血清白蛋白和CVC将患者分为4组，即0、1、2和3个危险标记组。前瞻性随访所有患者至死亡、退出腹透或至研究终止（2015年10月31日）。采用Cox比例风险模型分析0、1、2和3个危险标记对患者全因死亡和心血管死亡的预测作用。结果·共有189例患者入选本研究，其中男性99例（52.4%），平均年龄（55.8±15.2）岁，中位透析时间20（9~42.5）个月，32例（16.9%）患者合并糖尿病。有60例（31.7%）患者存在CVC。至研究终止，共有46例患者死亡，其中28例死于心血管事件。与无危险标记的患者相比，有3个危险标记和有2个危险标记的患者全因死亡HR分别是4.933 (95%CI为1.674~14.540，P=0.004) 和2.762 (95%CI 为1.107~6.892，P=0.029)，心血管死亡的HR分别是7.719（95%CI为1.916~31.088，P=0.004）和3.728 （95%CI 为1.126~12.344， P=0.031）。与任何一个危险标记相比，联合使用3个危险标记预测全因死亡和心血管死亡的受试者曲线下面积均增大。结论·联合应用炎症、营养不良和瓣膜钙化指标可更好地预测腹透患者的预后，对腹透患者进行全因死亡和心血管死亡的危险分层。

关键词: 炎症, 营养不良, 钙化, 死亡, 腹膜透析

Abstract:

Objective·To explore whether the combined use of inflammation, malnutrition, and cardiac valve calcification allows better all-cause and cardiovascular mortality risk stratification in peritoneal dialysis (PD) patients. Methods·Patients underwent regular PD in PD center of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from March 2011 to August 2013 were enrolled in this study. Cardiac valve calcification (CVC) in patients was detected using two-dimensional echocardiography. The patients were assigned to 4 groups based on 0, 1, 2 and all 3 risk markers, namely high high-sensitive C-reactive protein (hs-CRP), low serum albumin and CVC. All patients were followed up prospectively until death, PD discontinuation, or October 31, 2015. Cox proportional hazard model was used to analyze the prediction of all-cause and cardiovascular mortality by 0, any 1, 2 and all 3 risk markers. Results·A total of 189 PD patients with mean age of (55.8±15.2) years and median dialysis time of 20 months (9-42.5) were enrolled in this study. Among them, 99 (52.4%) were males and 32 (16.9%) had diabetes mellitus. CVC was presented in 60 (31.7%) patients. By the end of study, 46 patients died and 28 deaths were due to cardiovascular events. The patients with 3 and 2 markers had adjusted HR of 4.933 (95%CI 1.674-14.540，P=0.004) and 2.762 (95%CI 1.107-6.892，P=0.029) for all-cause mortality compared with those with 0 risk marker. The adjusted HR for cardiovascular mortality were 7.719 (95%CI 1.916-31.088, P=0.004) and 3.728 (95%CI 1.126-12.344, P=0.031) in patients with 3 and 2 markers. A combination of 3 markers increased the area under the curves of all-cause and cardiovascular mortality compared with any single marker. Conclusion·A combination of inflammation, malnutrition, and CVC can better predict the prognosis of PD patients and allow better all-cause and cardiovascular mortality risk stratification in PD patients.

Key words: inflammation, malnutrition, calcification, mortality, peritoneal dialysis