【摘要】 目的·探讨不同转运状态的新入腹膜透析(PD)患者的临床特点,对腹膜高转运状态的危险因素进行分析。方法·对2007年1月—2015年10月连续新入PD患者(455例)的临床资料进行回顾性分析。根据患者首次标准腹膜平衡实验(sPET)结果参考ISPD指南将患者分为H/HA组(4h D/Pcr≥0.65)与L/LA组(4h D/Pcr<0.65),比较2组临床及生化参数的差异;建立Logistic回归模型,分析高腹膜转运状态的危险因素。结果·共入选372例新入PD患者,L/LA组和H/HA组患者分别为264例(71.2%)和108例(28.8%)。相比L/LA组患者,H/HA组男性患者比例较高(63.0%vs 50.8%,P=0.03),残余肾功能较低[(4.26±2.77)mL/min vs(5.79±4.53)mL/min,P<0.01)],血清白蛋白水平较低[(29.34±6.89)g/L vs(32.08±5.86)g/L,P=0.00],糖尿病肾病比例较高(19.4%vs 9.5%,P=0.00)。Logistic回归分析结果显示:低白蛋白血症(OR=0.96,95%CI 0.28~0.99;P=0.02),男性(OR=1.92,95%CI 1.19~3.12;P=0.00),糖尿病肾病(OR=2.52,95%CI 1.26~5.05;P=0.00)及低残肾功能(OR=0.90,95%CI 0.83~0.96;P=0.00)是腹膜高转运状态的危险因素。进一步分析发现,与正常血白蛋白组相比,低血白蛋白组患者高敏C反应蛋白(hs CRP)水平更高(1.69 mg/L vs 0.69 mg/L,P=0.00)。结论·纳入患者初始腹透时以低及低平均转运状态为主。低白蛋白血症、男性、糖尿病肾病及低残余肾功能是腹膜高转运状态的危险因素。慢性炎症状态可能部分解释了PD患者低白蛋白血症与腹膜高转运状态的相关性。更多还原

【Abstract】 Objective · To investigate the clinical characteristics of initial peritoneal dialysis(PD) patients with different peritoneal transport status, and analyze risk factors of high peritoneal transport status in PD patients. Methods · A total of 455 consecutive PD patients newly starting PD between January 2007 to October 2015 were retrospectively analyzed. According to the results of the first sP ET, patients were divided into H/HA(4h D/Pcr ≥ 0.65) and L/LA(4h D/Pcr<0.65) groups. Clinical and biochemical characteristics between the two groups were compared. Multivariate logistic regression model was established to investigate risk factors of higher peritoneal transport status of incident PD patients. Results · The study included 372 incident PD patients. The L/LA group and H/HA group had 264 cases(71.2%) and 108 cases(28.8%) respectively. The H/HA group had higher proportion of male patients(63.0% vs 50.8%, P=0.03), lower residual renal function [RRF,(4.26±2.77) mL/min vs(5.79±4.53) mL/min, P<0.01], lower serum albumin level [(29.34±6.89) g/L vs(32.08±5.86) g/L, P=0.00], and more frequent diabetic nephropathy(19.4% vs 9.5%, P=0.00), compared with L/LA group. Univariate and multivariate logistic regression analysis showed that higher peritoneal transport status was associated with lower serum albumin level(OR=0.96, 95% CI 0.28-0.99; P=0.02), male(OR=1.92, 95% CI 1.19-3.12; P=0.00), presence of diabetic nephropathy(OR=2.52, 95% CI 1.26-5.05; P=0.00) and lower residual renal function(OR=0.90, 95% CI 0.83-0.96; P=0.00). The level of hsC RP in patients with hypoalbuminemia was higher than that in patients with normal albumin level(1.69 mg/L vs 0.69 mg/L, P=0.00). Conclusion · Low and low average peritoneal transport status accounted for the majority of the patients in this study. Low serum albumin levels, male, diabetic nephropathy, RRF were risk factors of initial high peritoneal solute transport status. Chronic inflammatory status might partially explain for the correlation between hypoalbuminemia and high peritoneal solute transport status in PD patients.更多还原