不同腹膜转运特性与腹膜透析患者的预后关系研究
发布时间：2019-02-25 08:59
【摘要】：研究背景：腹膜透析是终末期肾脏疾病患者替代治疗方式之一,在该人群中普遍存在着不同程度的营养不良及微炎症状态,影响其生活质量及预后。腹膜转运特性是腹膜透析效能的重要影响因素,可能会对CAPD患者的预后有一定影响。本研究通过分析不同腹膜转运特性的CAPD患者血生化、营养、炎症等指标的差异,探讨其与预后之间的关系,为临床实践提供客观依据。研究目的：1.探讨不同初始腹膜转运特性与腹膜透析患者的血生化、营养、炎症等相关指标的关系。2.回顾性研究本中心不同初始腹膜转运特性患者的预后差异。3.分析本中心腹透患者死亡及技术失败的独立危险因素。研究方法：选取我院2010年1月至2014年1月期间,接受持续不卧床式腹膜透析(CAPD)治疗至少2年以上的慢性肾衰竭患者为研究对象。评估患者腹膜溶质转运特性,根据6个月内PET试验结果作为患者初始腹膜特性来进行分组,即A组为低转运组(包含低转运及低平均转运类型)、B组为高转运组(包含高转运及高平均转运类型)。以开始腹透作为基线,记录两组患者的年龄、性别、教育程度、原发病、BMI、血糖、超滤量等基本信息。筛选我院腹透系统中两组患者不同时间段的血生化、营养、炎症等相关指标及末次随访时间、转归等数据。以患者死亡、转肾移植、转血透及截止2016年1月1日患者仍在腹透随访中作为研究终点。研究结果采用SPSS 22.0软件进行数据分析。研究结果：本研究显示,符合标准的我中心腹膜透析患者共计男性253例,女性198例；平均年龄48.2±13.3岁,平均末次随访时间37.0±17.6月；原发病以慢性肾小球肾炎为主,占65.4%,其次为糖尿病肾病,下一位是高血压肾病。451例接受CAPD治疗的患者中,其中有245例(54.3%)患者继续腹膜透析治疗,118例(26.2%)患者转肾移植,48例(10.6%)患者改血透治疗,40例(8.9%)患者死亡。与高转运组患者相比,低转运组患者在12月内的血肌酐、尿酸水平偏高,差异有统计学意义(P0.05)。与高转运组患者相比,低转运组患者在12月内的腹膜KTV、腹膜CCR偏低,差异有统计学意义(P0.05)。与高转运组患者相比,6月到36月期间低转运组患者炎症指标超敏CRP水平偏低,12月内营养指标如白蛋白较高,差异有统计学意义(P0.05)。初始腹膜转运特性与患者生存率无明显统计学差异(P0.05),与患者的技术生存率有统计学差异(P0.05)。腹透年龄是腹透患者死亡的独立危险因素(P0.05)。研究结论：本研究显示在12月内,高转运组患者的血肌酐、尿酸水平低于低转运组；高转运组患者的腹膜KT/V、CCR水平高于低转运组；高转运组患者的营养指标如白蛋白12月内低于低转运组,营养状况较差；6月到36月期间高转运组患者的炎症指标高于低转运组,腹膜炎发生风险较高；不同初始腹膜转运特性的患者生存预后无明显差异,低转运特性患者的技术生存率较高；腹透年龄是腹透患者死亡的独立危险因素。
[Abstract]:Background: peritoneal dialysis (PD) is one of the alternative therapies for end-stage renal diseases. Malnutrition and microinflammation are common in this population, which affects their quality of life and prognosis. Peritoneal transport is an important factor in the efficacy of peritoneal dialysis, which may have a certain impact on the prognosis of CAPD patients. The purpose of this study was to explore the relationship between blood biochemistry, nutrition and inflammation in patients with CAPD with different peritoneal transport characteristics, and to provide an objective basis for clinical practice. Objective: 1. To explore the relationship between different initial peritoneal transport characteristics and blood biochemical, nutritional, inflammatory and other related indexes in peritoneal dialysis patients. 2. A retrospective study was conducted on the prognosis of patients with different initial peritoneal transport characteristics in the center. 3. The independent risk factors of death and technical failure were analyzed. Methods: patients with chronic renal failure (CRF) who received continuous ambulatory peritoneal dialysis (CAPD) for at least 2 years from January 2010 to January 2014 were selected as the study subjects. To evaluate the peritoneal solute transport characteristics of patients, and group them according to the results of PET test within 6 months as the initial peritoneal characteristics of the patients, that is, group A was a low transport group (including low transport and low average transport types). Group B is high transport group (including high transport and high average transport type). The basic information of age, sex, education, primary disease, BMI, blood glucose and ultrafiltration were recorded. Blood biochemistry, nutrition, inflammation and the last follow-up time and prognosis of the two groups of patients in the abdominal dialysis system of our hospital were selected. Patients with death, renal transplantation, hemodialysis and follow-up of peritoneal dialysis as of January 1, 2016 were the end of the study. The data were analyzed by SPSS 22. 0 software. Results: in this study, 253 male and 198 female peritoneal dialysis patients met the criteria, with an average age of 48.2 卤13.3 years and an average follow-up time of 37.0 卤17.6 months. Chronic glomerulonephritis was the main primary disease, accounting for 65.4%, followed by diabetic nephropathy, followed by hypertension nephropathy. 245 (54.3%) of the 451 patients receiving CAPD treatment continued to be treated with peritoneal dialysis. 118 cases (26.2%) were transferred to renal transplantation, 48 cases (10.6%) were converted to hemodialysis, and 40 cases (8.9%) died. Compared with the high transport group, the serum creatinine and uric acid levels in the low transport group were higher than those in the high transport group within 12 months, the difference was statistically significant (P0.05). Compared with the high transport group, the peritoneal KTV, peritoneal CCR in the low transport group was lower in 12 months than that in the high transport group (P0.05). Compared with the patients with high transport, the level of hypersensitive CRP was lower in the low transport group from June to 36 months, and the nutritional index such as albumin was higher in 12 months, the difference was statistically significant (P0.05). There was no significant difference between the initial peritoneal transport characteristics and the survival rate (P0.05), but there was a significant difference between the initial peritoneal transport characteristics and the survival rate of the patients (P0.05). The age of peritoneal dialysis was an independent risk factor for death (P0.05). Conclusion: in this study, the serum creatinine and uric acid levels in high transport group were lower than those in low transport group, the peritoneal KT/V,CCR level in high transport group was higher than that in low transport group within 12 months. The nutritional index of high transport group was lower than that of low transport group within 12 months, and the nutritional status of high transport group was lower than that of low transport group, and the inflammatory index of high transport group was higher than that of low transport group during June to 36 months, and the risk of peritonitis was higher. The survival and prognosis of patients with different initial peritoneal transport characteristics were not significantly different, and the survival rate of patients with low transport characteristics was higher, and the age of peritoneal dialysis was an independent risk factor for the death of patients with peritoneal dialysis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692.5
本文编号：2430007
[Abstract]:Background: peritoneal dialysis (PD) is one of the alternative therapies for end-stage renal diseases. Malnutrition and microinflammation are common in this population, which affects their quality of life and prognosis. Peritoneal transport is an important factor in the efficacy of peritoneal dialysis, which may have a certain impact on the prognosis of CAPD patients. The purpose of this study was to explore the relationship between blood biochemistry, nutrition and inflammation in patients with CAPD with different peritoneal transport characteristics, and to provide an objective basis for clinical practice. Objective: 1. To explore the relationship between different initial peritoneal transport characteristics and blood biochemical, nutritional, inflammatory and other related indexes in peritoneal dialysis patients. 2. A retrospective study was conducted on the prognosis of patients with different initial peritoneal transport characteristics in the center. 3. The independent risk factors of death and technical failure were analyzed. Methods: patients with chronic renal failure (CRF) who received continuous ambulatory peritoneal dialysis (CAPD) for at least 2 years from January 2010 to January 2014 were selected as the study subjects. To evaluate the peritoneal solute transport characteristics of patients, and group them according to the results of PET test within 6 months as the initial peritoneal characteristics of the patients, that is, group A was a low transport group (including low transport and low average transport types). Group B is high transport group (including high transport and high average transport type). The basic information of age, sex, education, primary disease, BMI, blood glucose and ultrafiltration were recorded. Blood biochemistry, nutrition, inflammation and the last follow-up time and prognosis of the two groups of patients in the abdominal dialysis system of our hospital were selected. Patients with death, renal transplantation, hemodialysis and follow-up of peritoneal dialysis as of January 1, 2016 were the end of the study. The data were analyzed by SPSS 22. 0 software. Results: in this study, 253 male and 198 female peritoneal dialysis patients met the criteria, with an average age of 48.2 卤13.3 years and an average follow-up time of 37.0 卤17.6 months. Chronic glomerulonephritis was the main primary disease, accounting for 65.4%, followed by diabetic nephropathy, followed by hypertension nephropathy. 245 (54.3%) of the 451 patients receiving CAPD treatment continued to be treated with peritoneal dialysis. 118 cases (26.2%) were transferred to renal transplantation, 48 cases (10.6%) were converted to hemodialysis, and 40 cases (8.9%) died. Compared with the high transport group, the serum creatinine and uric acid levels in the low transport group were higher than those in the high transport group within 12 months, the difference was statistically significant (P0.05). Compared with the high transport group, the peritoneal KTV, peritoneal CCR in the low transport group was lower in 12 months than that in the high transport group (P0.05). Compared with the patients with high transport, the level of hypersensitive CRP was lower in the low transport group from June to 36 months, and the nutritional index such as albumin was higher in 12 months, the difference was statistically significant (P0.05). There was no significant difference between the initial peritoneal transport characteristics and the survival rate (P0.05), but there was a significant difference between the initial peritoneal transport characteristics and the survival rate of the patients (P0.05). The age of peritoneal dialysis was an independent risk factor for death (P0.05). Conclusion: in this study, the serum creatinine and uric acid levels in high transport group were lower than those in low transport group, the peritoneal KT/V,CCR level in high transport group was higher than that in low transport group within 12 months. The nutritional index of high transport group was lower than that of low transport group within 12 months, and the nutritional status of high transport group was lower than that of low transport group, and the inflammatory index of high transport group was higher than that of low transport group during June to 36 months, and the risk of peritonitis was higher. The survival and prognosis of patients with different initial peritoneal transport characteristics were not significantly different, and the survival rate of patients with low transport characteristics was higher, and the age of peritoneal dialysis was an independent risk factor for the death of patients with peritoneal dialysis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692.5
【参考文献】
相关期刊论文 前2条
1 谭融通;黄莉;李坚梅;;103例次持续性非卧床腹膜透析相关性腹膜炎的临床流行病学研究[J];重庆医学;2012年13期
2 孙晶;张焱;张虹;于克洲;王群;王荣;;低钙透析液对CAPD患者钙磷代谢的影响[J];中国血液净化;2009年05期
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