单中心腹膜透析患者的转归及其危险因素分析

袁鸣; 乔玉峰; 闫燕; 李晓霞; 薛福平; 刘红艳; 王利华

doi:10.3969/j.issn.1671-2390.2020.06.007

摘要: 目的分析山西医科大学第二医院腹膜透析中心腹透患者的临床资料，探讨腹透患者的转归及其危险因素。方法采用回顾性研究的方法，收集选取山西医科大学第二医院腹膜透析中心2009年1月至2019年6月期间维持性腹膜透析患者的临床资料，采用卡方检验和log rank检验进行单因素分析，采用多元逐步COX回归模型进行多因素分析，讨论腹膜透析患者的不良转归及其危险因素。结果 258例维持性腹透患者，原发病中慢性肾小球肾炎占42.2%，糖尿病肾病占32.9%；退出腹膜透析97例，退出率37.60%；退出腹膜透析患者中转血液透析者49例，占19.0%；死亡39例，占15.1%；肾移植4例，占退出的1.6%；失访5例。经单因素及多因素分析，合并心脑血管疾病（HR=2.599，95%CI：1.340~5.043，P=0.005）、24 h尿量小于400 mL （HR=0.207，95%CI：0.085~0.501，P<0.001）、肌酐小于707 μmol/L （HR=3.259，95%CI：1.682~6.316，P<0.001）是腹膜透析患者死亡的独立危险因素。腹膜炎的发生（HR=3.548，95%CI：1.882~6.691，P<0.001）、中性粒细胞百分比大于70%（HR=0.543，95%CI：0.302~0.977，P=0.042）、尿酸大于360 μmol/L （HR=0.352，95%CI：0.168~0.735，P=0.005）、总胆固醇大于5.7 mmol/L （HR=0.368，95%CI：0.160~0.931，P=0.034）是腹膜透析患者转血液透析的独立危险因素。结论我中心退出腹膜透析患者的转归主要为死亡及转血液透析。合并心脑血管疾病、24 h尿量小于400 mL、肌酐小于707 μmol/L是腹透患者死亡的独立危险因素；腹膜炎的发生、中性粒细胞百分比大于70%、尿酸大于360 μmol/L、总胆固醇大于5.7 mmol/L是腹透患者转血液透析的独立危险因素。

Abstract: Objective To analyze the clinical data of peritoneal dialysis(PD)patients in the Second Hospital of Shanxi Medical University,and to explore the outcomes of patients with PD and the risk factors.Methods The clinical data of patients with maintenance peritoneal dialysis from January 2009 to June 2019 in the Second Hospital of Shanxi Medical University were collected by retrospective study.The chi-square test and log rank test were used for single factor analysis.Multivariate analysis was performed using a multivariate stepwise COX regression model to discuss the adverse outcomes and risk factors of peritoneal dialysis patients.Results Among 258 patients with maintenance peritoneal dialysis,the ones with chronic glomerulonephritis accounted for 42.2%,the ones with diabetic nephropathy 32.9%;97 ones withdrew from peritoneal dialysis with a withdrawal rate of 37.60%.Among the patients with withdrawal from peritoneal dialysis,49 ones changed from peritoneal dialysis to hemodialysis,accounting for 19.0%;39 ones died,accounting for 15.1%;4 ones underwent renal transplantation,accounting for 1.6%;5 patients lost their follow-up visit.Through single factor and multi factor analysis,the complication of cardiovascular and cerebrovascular diseases(HR=2.599,95%CI:1.340~5.043,P=0.005),24-hour urine volume less than 400 mL(HR=0.207,95%CI:0.085~0.501,P<0.001),creatinine less than 707 μmol/L(HR=3.259,95%CI:1.682~6.316,P<0.001)were the independent risk factors for death in patients with peritoneal dialysis.The incidence of peritonitis(HR=3.548,95%CI:1.882~6.691,P=0.000),neutrophil percentage greater than 70%(HR=0.543,95%CI:0.302~0.977,P=0.042),uric acid greater than 360 μmol/L(HR=0.352,95%CI:0.168~0.735,P=0.005),total cholesterol greater than 5.7mmol/L(HR=0.368,95%CI:0.160~0.931,P=0.034)were the independent risk factors for change to hemodialysis.Conclusions The outcomes of patients who withdraw from peritoneal dialysis in our center are mainly death and change to hemodialysis.The complication of cardiovascular and cerebrovascular diseases,24-hour urine volume less than 400 mL,and creatinine less than 707 μmol/L are independent risk factors for death in patients with peritoneal dialysis.Peritonitis,neutrophil percentage greater than 70%,uric acid greater than 360 μmol/L,total cholesterol greater than 5.7 mmol/L are independent risk factors for change to hemodialysis.

单中心腹膜透析患者的转归及其危险因素分析

Analysis of outcomes and risk factors in peritoneal dialysis patients in a single center