基线腹膜转运特性及其变化对维持性腹膜透析患者预后的影响

发布时间：2018-03-31 10:00

  本文选题：腹膜透析　切入点：腹膜转运特性　出处：《浙江大学》2017年硕士论文

【摘要】：背景:传统观点认为腹膜小分子溶质高转运是腹透患者的死亡率及技术失败率的重要预测因子,而腹透患者尤其是基础腹膜高转运患者的预后存在差异,且随着透析时间的延长腹膜转运特性会发生改变。目的:本研究通过回顾性分析维持性腹膜透析患者的基线腹膜转运特性及在透析过程中的变化趋势,评估其对腹透患者预后的影响;进一步分析基线腹膜转运特性为高转运的维持性腹膜透析患者的预后差异,并评估影响其预后的相关因素。方法:1.采用Kaplan-Meier生存分析比较4组患者的生存率、技术生存率。随访复查入选2006年9月11日至2014年10月30日在本院开始维持性腹透且资料完整患者586例。所有入选患者在腹膜透析开始6个月内行基础腹膜平衡试验,并规律复查。根据基础透出液/血浆肌酐浓度比值(D/Pcr)将患者分为4组,0.82～1.03为高转运组(H),0.65～0.81为高平均转运组(HA),0.50～0.64为低平均转运组(LA),0.34～0.49为低转运组(L)。D/Pcr值将患者腹膜转运特性同上分组,并与相应的基线腹膜转运特性分组相比较,依据变化趋势分为增高组、降低组和不变组,Kaplan-Meier生存分析评估不同转运特性变化患者的预后。2.亚组分析基础腹膜转运特性为较高转运(D/Pcr≥0.65)的患者290例,根据随访截止终点患者生存及技术生存进行分组,比较两组间相关指标的差异,COX生存回归分析预后不良的相关影响因素。结果:1.L组67人,LA组229人,HA组252人,H组38人,高转运组患者累积生存率显著低于低转运组(P=0.04)、低平均转运组(P0.01)、高平均转运组(P=0.04),其余各组间无显著差异;技术生存率各组间无显著差异。透析时年龄≥65岁(HR=2.499)、随访时营养不良(HR=3.144)、随访超滤量≤400 ml/d(HR=1.863)、超敏C反应蛋白水平≥10 mg/L(HR=4.526)是患者死亡的独立危险因素。2.随访复查D/Pcr值增高组127人、降低组101人、不变组179人;3组间患者生存率差异无统计学意义(P=0.064)。但在基础转运率较高(D/Pcr≥0.65)的患者中,复查D/Pcr下降组的生存率低于增高组(P=0.03)及不变组(P=0.05)。3.对于基础转运率较高(D/Pcr0.65)的患者进行亚组分析,较高转运组共计290人,平均随访41.5(3～116)月,死亡41人,转血液透析50人。患者生存率为85.9%,COX回归分析显示高龄(HR=3.368)、Charlson合并症指数(CCI指数)高(HR=2.478)、随访期超滤下降(HR=6.750)、随访期营养不良(HR=5.255)、持续非卧床腹膜透析(CAPD)模式(HR=4.336)是基础腹膜高转运患者死亡的独立危险因素;技术生存率为68.6%,COX回归分析显示高龄(HR=2.552)、随访期营养不良(HR=2.179)、随访期超滤下降(HR=2.234)是患者退出腹膜透析的独立危险因素。结论:基础腹膜高转运患者生存率较低,特别是随访期腹膜转运率下降者患者生存率更差。关注腹膜高转运患者预后不良的独立危险因素如超滤下降、营养不良及合并症的预防与治疗,采用合适的透析治疗模式,可改善其生存率。
[Abstract]:Background: the traditional view is that high transport of small molecular solute in peritoneal cavity is an important predictor of mortality and failure rate of technique in patients with peritoneal dialysis, and the prognosis of patients with peritoneal dialysis, especially those with high transport of basic peritoneum, is different. With the prolongation of dialysis time, the peritoneal transport characteristics will change. Objective: to analyze the baseline peritoneal transport characteristics and the trend of peritoneal transport during dialysis in patients with maintenance peritoneal dialysis (MPD). To assess its impact on the prognosis of patients with peritoneal dialysis, and to further analyze the differences in prognosis in patients with maintenance peritoneal dialysis whose baseline peritoneal transport is high transport. Methods 1. Kaplan-Meier survival analysis was used to compare the survival rate of the four groups. Technique survival rate. 586 patients with complete data from 11 September 2006 to 30 October 2014 were enrolled in this study. All patients underwent the basic peritoneal balance test within 6 months of the beginning of peritoneal dialysis. The patients were divided into 4 groups according to the ratio of basic permeable fluid / plasma creatinine concentration (D / Pcr). The patients were divided into 4 groups. The patients were divided into 4 groups: high transport group: high transport group: high average transport group: high average transport group: high average transport group: high average transport group: high average transport group: low average transport group: low average transport group: low transport group: Ln = 0.340.49. Compared with the corresponding baseline peritoneal transport characteristics, the patients were divided into two groups according to the trend of change. Kaplan-Meier survival analysis was used to evaluate the prognosis of patients with different transport characteristics. 2. The subgroup analyzed 290 patients whose basic peritoneal transport characteristics were higher than 0.65). The patients were divided into two groups according to survival and technical survival at the end of follow-up. The correlation factors of poor prognosis in Cox regression analysis were compared between the two groups. Results (1) 67 patients in L group, 229 patients in LA group, 252 patients in HA group, 38 patients in H group. The cumulative survival rate in the high transport group was significantly lower than that in the low transport group (P 0.04), the low average transport group (P 0.01) and the high average transport group (P < 0.04). There was no significant difference among the other groups. There was no significant difference in survival rate among the groups. Age 鈮，

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