中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (04): 205-210.doi: 10.3969/j.issn.1671-4091.2016.04.005

• 临床研究 • 上一篇    下一篇

腹膜透析患者体质量指数与技术生存间的关系

曾秀琴1.2,黄晓彦1,王青1,熊子波1,廖玉梅1,熊祖应1   

  1. 1. 北京大学深圳医院肾内科  2. 汕头大学医学院（现于惠州市第三人民医院工作）
  • 收稿日期:2015-10-21 修回日期:2016-01-03 出版日期:2016-04-12 发布日期:2016-04-19
  • 通讯作者: 黄晓彦 huangxy@bjmu.edu.cn E-mail:xiongzy2005@163.com
  • 基金资助:

    国家自然科学基金青年项目(81402737)，深圳市科创委2014 年科技计划资助项目(201404153000584），北京大学深圳医院学科骨干基金(201425）

Body mass index and technical survival in patients undergoing peritoneal dialysis

  • Received:2015-10-21 Revised:2016-01-03 Online:2016-04-12 Published:2016-04-19

RichHTML

0

PDF

264

摘要： 目的探讨腹膜透析(peritoneal dialysis，PD)患者体质量指数(body mass index，BMI)与技术生存间关系。方法本课题是回顾性队列研究。研究人群为2000～2014 年在北京大学深圳医院新入PD 治疗并规律随访的348 例患者，年龄(48.2±15.5)岁，其中62%为男性。根据透析治疗2～6 个月间首次记录的体质量及身高计算BMI，按照世界卫生组织的亚洲人推荐标准，对患者进行分组。患者均随访至死亡、转为血液透析、肾移植、失随访或至2014 年10 月31 日。主要终点是技术失败(死亡或永久转为血液透析)，次要终点包括全因死亡、心脑血管死亡、心血管事件、脑卒中事件、首次发生腹膜炎。数据分析采用多因素Cox 回归模型。结果调整年龄、性别、文化程度、原发病和心力衰竭后，低BMI 组和高BMI 组患者的技术失败风险比(95%可信区间，P 值)分别是正常组的3.590[(1.526,8.447)，P= 0.003] 和0.932[(0.493,1.762)，P=0.829]倍。相较于正常BMI 组，低BMI 组的全因死亡率(HR5.462,95%可信区间1.743～17.110，P=0.004)与心脑血管死亡率[HR 9.403，95%可信区间2.409～36.700，P=0.001)亦显著升高，而高BMI 组则未发现明显差异(P 值均＞0.05)。BMI 和冠状动脉粥样硬化性心脏病(冠心病)事件、脑卒中事件与腹膜炎等次要终点不存在统计学意义的关系(P 值均＞0.05)。亚组分析提示BMI 与技术生存的关系不受年龄、性别、文化程度、原发病、心脑血管并发症等因素影响(交互作用P 值均＞0.05)。结论PD 患者中，低BMI 与技术失败、全因死亡、心脑血管事件死亡独立相关，但与冠心病、脑卒中和腹膜炎等无关联；高BMI与上述终点事件均无关联。

关键词: 腹膜透析, 体重指数, 技术生存, 回顾性队列研究, Cox回归分析

Abstract: Objective To investigate the relationship between body mass index (BMI) and technical survival in peritoneal dialysis (PD) patients. Methods A total of 348 PD patients (aged 48.2±15.5 years, 62% males) treated in Peking University Shenzhen Hospital from 2000 to 2014 were enrolled in this retrospective and cohort study. BMI was calculated using the first recorded body height and weight within 2~6 months after the initiation of PD. Patients were grouped according to the recommendation by World Health Organization for Asians. All patients were followed up until death, transferring to hemodialysis, kidney transplantation, loss
of follow-up, or Oct. 31, 2014. The main endpoint included technical failure (death or permanently transferred to hemodialysis), and the secondary endpoint consisted of all-cause mortality, cardiovascular and cerebrovascular mortality, coronary heart disease event, stroke, and the first episode of peritonitis. Cox regression was used for data analysis. Results After the adjustment of age, sex, education, primary disease and heart failure, the hazard ratio (HR) for technical failure was 3.590 (95% CI 1.526~8.447, P=0.003) in low BMI group and was 0.932 (95% CI 0.493~1.762, P=0.829) in high BMI group, as compared with that in normal BMI. Allcause mortality, and cardiovascular and cerebrovascular mortality were higher in low BMI group than in normal BMI group (in low BMI group, total mortality HR=5.462, 95% CI 1.743~17.110, P=0.004; cardiovascular and cerebrovascular mortality HR=9.403, 95% CI 2.409~36.700; P=0.001), but were similar between high BMI group and normal BMI group (P＞0.05). No statistical significance was found in the relationship between BMI and the secondary endpoint including coronary heart disease event, stroke, and the episode of peritonitis (P＞0.05). Subgroup analyses revealed that the relationship between BMI and technical failure was not affected by age, sex, education, primary disease and cardiovascular diseases (interacted P＞0.05). Conclusions In PD patients, low BMI was independently associated with technical failure, all-cause mortality, and cardiovascular and cerebrovascular mortality, but not with coronary heart disease event, stroke and the episode of peritonitis. However, high BMI was unrelated to the events of main endpoint and secondary endpoint.

Key words: Peritoneal dialysis, body mass index, technical survival, retrospective cohort study, Cox regression