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腹膜透析溶质高转运患者预后危险因素分析
吴炜飞, 韩飞, 谢锡绍, 林君, 殷晓红, 张晓辉, 陈江华
浙江大学医学院附属第一医院肾脏病中心
摘要:
目的回顾性分析基础腹膜溶质高转运特性的维持性腹膜透析患者临床资料，分析影响其预后的危险因素。方法选取新置透析导管接受腹膜透析治疗，且基础腹膜溶质转运特性为高转运的患者290例，随访记录患者临床资料，根据截止随访时间患者的生存状态将其分为生存组与死亡组。比较两组患者的临床资料，并分析影响患者预后的危险因素。结果至随访截止日期，生存组患者249例，死亡组患者41例，病死率14.1%。死亡组患者年龄、Charlson合并症指数（CCI指数）、持续非卧床腹膜透析（CAPD）模式治疗比例、随访期营养不良率均高于生存组（均P＜0.05），随访期超滤量低于生存组（P＜0.05）。多因素Cox回归分析显示高龄（HR=3.368）、CCI指数高（HR=2.478）、CAPD模式治疗（HR=4.336）、随访期营养不良（HR=5.255）、随访期超滤量不足（HR=6.750）均是影响腹膜透析溶质高转运患者预后的独立危险因素（均P＜0.05）。结论临床表现不同的腹膜透析溶质高转运患者预后存在差异，关注影响其预后的独立危险因素并采取相应的预防、治疗措施或可降低其死亡风险。
关键词:  腹膜透析 腹膜溶质高转运 预后 危险因素
DOI：10.12056/j.issn.1006-2785.2017.39.02.2016-1747
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基金项目:
Risk factors of mortality in patients on maintenance peritoneal dialysis with high peritoneal transport status
WU Weifei, HAN Fei, XIE Xishao, LIN Jun, YIN Xiaohong, ZHANG Xiaohui, CHEN Jianghua
the First Affiliated Hospital，Zhejiang University School of Medicine
Abstract:
Objective To analyze the risk factors of mortality in patients on maintenance peritoneal dialysis (PD) with high peritoneal transport characteristics. Methods Clinical data of 290 PD patients with high peritoneal transport status, including biochemical findings, dialysis adequacy, peritonitis and nutritional status, were retrospectively analyzed. The Cox regression model was used to analysis the risk factors for death-censored technique failure and mortality. Results Patients were followed up until March 30, 2016 with a mean follow-up time of 41.5 (3-116) months. Among 290 patients, 41 died and 50 were switched to hemodialysis with a fatality rate of 14.1% . The COX regression model showed that the age (HR = 3.368), high Charlson Comorbidity Index (CCI) (HR = 2.478), decreased ultrafiltration volume (HR= 6.750), malnutrition (HR =5.255), PD model (HR = 4.336) were the independent risk factors of mortality in patients with high peritoneal transport status at baseline. Conclusion The clinical outcome of PD patients with high peritoneal transport status varies. Pay attention to the risk factors of poor prognosis, and taking appropriate prevention and treatment measures may improve the survival of patients.
Key words:  Peritoneal dialysis High peritoneal transport status Prognosis Risk factors