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  • 陈胜芳,陈昱颉,张坤,等.持续非卧床腹膜透析患者结局预测因素分析[J].同济大学学报(医学版),2021,42(1):74-79.    [点击复制]
  • CHEN Sheng-fang,CHEN Yu-jie,ZHANG Kun,et al.Predictive factors for outcomes of patients undergoing continuous ambulatory peritoneal dialysis[J].同济大学学报(医学版),2021,42(1):74-79.   [点击复制]
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持续非卧床腹膜透析患者结局预测因素分析
陈胜芳,陈昱颉,张坤,崔春黎
0
(上海中医药大学附属曙光医院营养科,上海201203;同济大学附属同济医院肾内科,上海200065)
摘要:
目的了解持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis, CAPD)患者累积生存率,分析CAPD患者结局的预测因素。方法采用前瞻性观察研究方法,连续纳入符合观察条件的CAPD患者148例,调查生活方式并检测腹膜透析前基线肾功能和血清生化指标,采用Kaplan-Meier法分析生存率,Cox比例风险回归模型分析结局影响因素。结果中位随访时间78个月,CAPD患者3年和5年生存率分别为71.2%和53.7%,心脑血管死因占53.2%,血清钙磷乘积是心脑血管死因的独立影响因素;中三分位血清钙磷乘积比高三分位血清钙磷乘积死亡风险减少76.2%(OR=0.238,95%CI 0.070~0.814,P=0.022)。多因素Cox比例模型分析显示,高龄、低血清白蛋白(albumin,Alb)和总淋巴细胞计数(total lymphocyte count, TLC)是CAPD患者全因死亡风险的预测因子。与<60岁的患者比较,年龄60~75岁和>75岁患者死亡风险显著增加(HR=2.176,95%CI 1.213~3.902,P=0.009;HR=3.584,95%CI 1.914~6.636,P<0.001);与血清Alb>30g/L的患者比较,血清Alb 25~30g/L和Alb<25g/L的患者死亡风险增加(HR=1.753,95%CI 1.009~3.046,P=0.047;HR=2.075,95%CI 1.125~3.829,P=0.020);与低三分位TLC比较,中三分位TLC的患者死亡风险减少50.8%(HR=0.492,95%CI 0.276~0.876,P=0.016)。结论心脑血管事件是CAPD患者的主要死亡原因,基线高龄、低血清Alb和TLC是CAPD患者全因死亡风险的预测因子。
关键词:  腹膜透析  全因死亡率  低蛋白血症  淋巴细胞计数  心脑血管事件
DOI:10.12289/j.issn.1008-0392.20189
投稿时间:2020-03-19
基金项目:
Predictive factors for outcomes of patients undergoing continuous ambulatory peritoneal dialysis
CHEN Sheng-fang,CHEN Yu-jie,ZHANG Kun,CUI Chun-li
(Dept. of Clinical Nutrition, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;Dept. of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China)
Abstract:
ObjectiveTo analyse the predictive factors for outcomes of patients on continuous ambulatory peritoneal dialysis (CAPD). MethodsA total of 148 patients with CAPD were consecutively included the study. The lifestyle was investigated, anthropometric measurements were performed, and baseline renal function and serum biochemical indicators were measured before peritoneal dialysis. Survival rates were analyzed by Kaplan-Meier method and outcome predictors were analyzed by Cox proportional hazards regression model. ResultsThe median follow-up time was 78 months. The 3-year and 5-year survival rates of patients on CAPD were 71.2%, and 53.7%, respectively. The cause of cardio-cerebrovascular death accounted for 53.2%. Serum calcium-phosphorus product was an independent determinant of cardio-cerebrovascular death. Compared with the upper tertile serum calcium-phosphorus product, the medium tertile serum calcium-phosphorus product reduced the risk of death by 76.2%(OR=0.238, 95%CI 0.070-0.814, P=0.022). Multivariate Cox model stepwise regression analysis showed that older age, lower serum albumin (Alb), and total lymphocyte count (TLC) were predictors of all-cause death in patients on CAPD. Compared with patients <60 years, the risk of death was significantly increased in patients aged 60-75 years and >75 years (HR=2.176, 95%CI 1.213-3.902, P=0.009;HR=3.584, 95%CI 1.914-6.636, P<0.001). Compared with serum Alb> 30g/L, patients with serum Alb 25-30g/L and <25g/L had increased risk of death (HR=1.753, 95%CI 1.009-3.046, P=0.047; HR=2.075, 95%CI 1.125-3.829, P=0.020). And compared with the lower tertile TLC, the risk of death in patients with the medium tertile TLC was reduced by 50.8%(HR=0.492, 95%CI 0.276-0.876, P=0.016). ConclusionCardio-cerebrovascular events are the main cause of death in patients on CAPD. The older age, lower serum Alb level and TLC are predictors of all-cause mortality in patients on CAPD.
Key words:  peritoneal dialysis  all-cause mortality  hypoproteinemia  lymphocyte count  cardio-cerebral vascular events

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