中国血液净化

›› 2008, Vol. 7 ›› Issue (3): 130-133.

• 论著 • 上一篇    下一篇

持续腹膜透析患者的生存率及多变量预后分析

陈丽萌 徐 虹 周紫娟 李雪梅 崔 莹 杨 威 孙 阳 李学旺   

  1. 中国医学科学院北京协和医院肾内科
  • 收稿日期:2008-01-15 修回日期:1900-01-01 出版日期:2008-03-12 发布日期:2008-03-12
  • 通讯作者: 李雪梅

Survival rate and multivariate analysis of prognostic factors in continuous ambulatory peritoneal dialysis patients

CHEN Li-meng, XU Hong, ZHOU Zi-juan, LI Xue-mei, CUI Ying, YANG Wei, SUN Yang, LI Xue-wang   

  • Received:2008-01-15 Revised:1900-01-01 Online:2008-03-12 Published:2008-03-12

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摘要： 【摘要】目的 分析腹膜透析病人的生存率及其独立的预后因素，观察腹膜转运特性及相关临床特点对患者生存的影响。方法 随诊腹膜透析病人232例，采用Cox 模型回归分析透析开始时各临床指标对生存时间的影响。结果 CAPD病人1年、2年、3年及4年总体生存率分别为91.1%、77.7%、68.7%及55.8%；单因素COX模型回归分析表明：糖尿病患者、腹膜高转运状态、年龄增加、血浆白蛋白低于3.0的患者预期生存率均降低(P＜0.05)。232例患者中180(78%)位患者在开始透析的前6个月完成腹膜平衡实验(PET)，其中高转运状态与死亡显著相关(与低于平均转运患者相比，RR 2.70；95% CI 1.03 to 7.05；P = 0.043)。经多因素COX模型回归分析，糖尿病和年龄是尿毒症腹膜透析患者死亡的独立危险因素。糖尿病患者死亡的相对危险度为非糖尿病患者的2.96倍（95% CI 1.62 to5.38；P＜0.0001）；年龄每增加10岁，相对危险度增加0.31(P =0.039)。结论 根据透析前年龄、原发病、血清白蛋白和腹膜的转运状态可以对腹透病人的预后进行初步判断。

关键词: 腹膜透析, 预后, 腹膜转运

Abstract:

【Abstract】Objective The aim of this study was to identify risk factors influencing survival and to determine baseline peritoneal transport status in the prediction of subsequent survival in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods This study included all adult patients who commenced peritoneal dialysis in this hospital between Jan. 1, 1996, and Dec. 31, 2007, and had a peritoneal equilibration test (PET) performed within 6 months of peritoneal dialysis commencement. Times to death and death-censored technique failure were examined by Kaplan-Meier analyses and multivariate Cox proportional hazards models. Results The overall survival probability after 1 , 2 , 3 and 4 years was 91.1%，77.7%，68.7% and 55.8%, respectively. Patients with diabetes, higher peritoneal transport status, advanced age, serum albumin < 30 g/ L, had lower survival probabilities. PET was performed in 180 (78%) of the 232 patients who were treated with peritoneal dialysis in this hospital during the study period. In these patients, higher transport status was found to be a significant predictor of mortality (relative risk 2.70; 95% CI 1.03-7.05; P = 0.043, as compared to those with transport status lower than average). Cox regression showed that advanced age and diabetes were the independent prognostic predictors. The relative risk (RR) of mortality in diabetic patients was 2.96 times higher than that in non-diabetic patients (95% CI 1.62-5.38; P <0.0001). As age increased by 10 years, the RR increased 0.31 (P=0.039). Conclusion The prognosis of peritoneal dialysis patients can be preliminarily predicted before the initiation of peritoneal dialysis based on their age, primary diseases, peritoneal transport status and serum albumin.

Key words: Prognosis, Transport status