影响腹膜透析患者身体机能状态的临床相关因素分析

    Analysis of clinically related factors influencing functional performance of peritoneal dialysis patients

      摘要
    • 摘要: 目的 对腹膜透析（PD）患者影响身体机能状态的临床相关因素的研究较少，本研究旨在通过使用Karnofsky身体机能状态量表（KPSS）评估患者的身体机能状态，探讨KPSS与PD患者临床参数之间的相关性。方法 本研究回顾性调查了2008年3月至2017年4月天津市第一中心医院和1999年2月至2009年7月台湾高雄长庚纪念医院常规接受PD治疗至少3个月，且年龄在18~80岁之间的491例患者。收集患者人口统计学特征、血生化指标以及PD相关参数。采用KPSS评分评估患者的身体机能状态。通过性别、年龄和PD透析龄进行倾向评分匹配，将受试者进一步分层为高（KPSS≥80，n=121）和低（KPSS<70，n=121）KPSS群组。通过多变量逻辑回归分析，计算各临床参数对低KPSS评分的优势比（OR）。结果 低KPSS评分的PD患者与高KPSS评分者相比，合并糖尿病者较多，查尔森合并症指数较高（Charlson），具有较低的血清白蛋白和胆固醇水平，较低的尿素氮清除率（Kt/V）（总和残肾），较低的肌酐清除率，较低的标准蛋白质分解率（nPCR）。通过Logistic回归分析显示：合并糖尿病（OR 3.75； 95％CI 1.43~9.87，P=0.007）以及血尿素氮（OR 1.02； 95％CI 1.01~1.04，P=0.004）是PD患者低KPSS评分的危险因素。相反，较高的血清白蛋白（OR 0.30； 95％CI 0.12~0.79，P=0.014）和nPCR（OR 0.08； 95％CI 0.01~0.41，P=0.003）为PD患者的低KPSS评分的保护性因素。结论 PD患者身体机能状态低下与糖尿病病史及血尿素氮水平相关，较高的血清白蛋白和nPCR水平可防止PD患者身体机能下降的出现。

       

      Abstract: Objective The functional performance and related factors are rarely known in peritoneal dialysis (PD) patients. This study aimed to evaluate functional performance of PD patients by using the Karnofsky Performance Status Scale (KPSS) scores, and to investigate its relationship with clinical parameters. Methods A total 491 prevalent PD patients at the age of 18-80 from two hospital-facilitated PD centers (The Tianjin First Central Hospital, from March 2008 to April 2017; Gaoxiong Changgeng Memorializing Hospital, Taiwan, from February 1999 to July 2009) were recruited for retrospective analysis. These patients had received regularly PD treatment for at least 3 months. The collected data included demographic characteristics, blood biochemical parameters, comorbidities and PD related parameters. KPSS score was used to assess functional performance. The subjects were further stratified into high (>80, n=121) and low (<70, n=121) KPSS cohorts by propensity score matching through gender, age and PD age. By multivariate logistic regression analyses, odds ratios (ORs) of various clinical parameters to low KPSS scores were calculated for low KPSS scores. Results Compared to the patients with high KPSS scores, the ones with low KPSS scores showed predominant complicated diabetes, higher Charlson index, lower serum albumin and cholesterol levels, lower urea nitrogen clearance (Kt/V) (total and residual renal), lower creatinine clearance, decreased normalized protein catabolic rate (nPCR). By multivariate analyses, complicated diabetes (OR 3.75; 95%CI 1.43~9.87,P=0.007) and blood urea nitrogen (BUN) (OR 1.02; 95%CI 1.01~1.04,P=0.004) showed risk factors for low KPSS scores in PD patients. In contrast, high serum albumin (OR 0.30; 95%CI 0.12~0.79,P=0.014) and nPCR (OR 0.08; 95%CI 0.01~0.41,P=0.003) exhibited a protective factor for low KPSS scores in PD patients.Conclusions PD patients with low functional performance are significantly associated with a history of diabetes and BUN level. High serum albumin and nPCR are associated with decreased risk for low functional performance in PD patients.

       

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