中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (11): 899-903.doi: 10.3969/j.issn.1671-4091.2025.11.005

• 健康体重·医者先行 • 上一篇    下一篇

体质量指数联合标准蛋白分解率在腹膜透析患者容量识别中的预测价值

张 曼   索金雅   陈赟敏   许晓惠   余 乐   俞雨生   周婷婷   

  1. 210002 南京，1东部战区总医院 国家肾脏疾病临床医学研究中心
  • 收稿日期:2025-01-06 修回日期:2025-07-29 出版日期:2025-11-12 发布日期:2025-11-12
  • 通讯作者: 周婷婷 E-mail:382881190@qq.com
  • 基金资助:
    江苏省实施“终末期肾病患者腹膜透析治疗可及性及其基层管理模式探索项目”(YYS2016001)

Predictive value of body mass index combined with normalized protein catabolic rate for volume status identification in peritoneal dialysis patients

ZHAGN Man，SUO Jin-ya，CHEN Yun -min, XU Xiao-hui，Yu Le, YU Yu-sheng，ZHOU Ting-ting   

  1. Department of Nephrology, National Clinical Research Center of Kidney Disease, Jinling Hosptial, Nanjing University School of Medicine, Nanjing 210002, China
  • Received:2025-01-06 Revised:2025-07-29 Online:2025-11-12 Published:2025-11-12
  • Contact: 210002 南京，1东部战区总医院 国家肾脏疾病临床医学研究中心 E-mail:382881190@qq.com

摘要： 目的  探讨体质量指数(body mass index，BMI)联合标准蛋白分解率对腹膜透析患者容量识别的预测价值。 方法  本研究为单中心回顾性研究，纳入2004年3月─2024年3月在东部战区总医院行腹膜透析治疗的患者，根据心胸比(cardiothoracic ratio,CTR)值，将患者分为容量正常组(CTR＜0.5)、容量超负荷组(CTR≥0.5)，收集相关资料，采用单因素分析和二元Logistic回归分析筛选腹膜透析患者容量超负荷的影响因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析BMI联合标准蛋白分解率(normalizing protein catabolic rate，nPCR)对容量超负荷的诊断价值。 结果  共纳入2109例患者，容量正常组1002例，容量超负荷组1107例。二元Logistic回归进行多因素分析，结果显示：nPCR(OR=0.022，95%CI:0.011～0.046,P＜0.001)、总肌酐清除率(OR=0.988，   95%CI：0.980～0.996,P=0.004)、血清白蛋白(OR=0.944，95%CI:0.915～0.974，P＜0.001)、透析龄(OR=1.004，95%CI:1.000～1.008，P=0.028)、血红蛋白(OR=0.888，95%CI:0.834～0.946，P＜0.001)、BMI(OR=1.290，95%CI:1.230～1.354，P＜0.001)、尿量(OR=0.999，95%CI:0.999～1.000,P＜0.001)是腹膜透析患者容量超负荷的独立危险因素。ROC曲线下面积(area under the curve,AUC)显示，nPCR(AUC =0.749，95% CI:0.686～0.730)，BMI(AUC =0.702，95% CI:0.680～0.724)，BMI联合nPCR(AUC=0.759，95%CI:0.739～0.780)预测PD患者容量负荷差异有统计学意义(P＜0.001)。 结论  BMI联合nPCR是腹膜透析患者发生容量超负荷的良好预测指标。

关键词: 标准蛋白分解率, 体质量指数, 腹膜透析, 容量超负荷

Abstract: Objective To investigate the predictive value of body mass index (BMI) combined with normalizing protein catabolic rate (nPCR) for identifying volume status in peritoneal dialysis (PD) patients.  Methods  This is a single-center retrospective study, patients who underwent maintenance PD treatment at the Jinling Hosptial, Nanjing University School of Medicine from March 2004 to March 2024 were included. Based on the cardiothoracic ratio (CTR), the patients were divided into normal volume group (CTR＜0.5) and volume overload group (CTR≥0.5). Relevant data were collected, and univariate analysis and binary Logistic regression analysis were used to screen the influencing factors of volume overload in PD patients. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of BMI combined with nPCR for volume overload.  Results  A total of 2109 patients were included, including 1002 patients in the normal volume group and 1107 patients in the volume overload group. Multivariate binary logistic regression analysis showed that  nPCR (OR=0.022, 95% CI:0.011～0.046, P＜0.001), total creatinine clearance (OR= 0.988,  95% CI: 0.980～0.996, P=0.004), serum albumin (OR=0.944, 95% CI: 0.915～0.974, P＜0.001), dialysis vintage (OR=1.004, 95% CI:1.000～1.008, P=0.028), hemoglobin (OR=0.888, 95% CI:0.834～0.946, P＜ 0.001), BMI (OR=1.290, 95% CI: 1.230～1.354, P＜0.001), and urine output (OR=0.999, 95% CI: 0.999～1.000, P ＜ 0.001) were independent risk factors for volume overload in PD patients. The area under the ROC curve (AUC) showed that nPCR (AUC=0.749, 95% CI: 0.686～0.730), BMI (AUC=0.702, 95% CI: 0.680～0.724), and the combination of BMI and nPCR (AUC 0.759, 95% CI: 0.739～0.780) had statistically significant predictive value for volume overload in PD patients (P＜0.001).  Conclusion  The combination of BMI and nPCR is a good predictor of volume overload in PD patients.

Key words: Normalizing protein catabolic rate；Body mass index, Peritoneal dialysis, Volume overload

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