中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (11): 606-610.

• 专题 • 上一篇    下一篇

糖尿病腹膜透析患者的长期预后及死亡危险因素研究

张琳1,方炜2,刘曜蓉2   

  1. 1. 上海交通大学医学院附属仁济医院肾脏科 上海市腹膜透析研究中心
    2. 上海交大医学院附属仁济医院
  • 收稿日期:2012-07-23 修回日期:2012-08-26 出版日期:2012-11-12 发布日期:2012-11-12
  • 通讯作者: 张琳 E-mail:fangwei_sh@126.com

  • Received:2012-07-23 Revised:2012-08-26 Online:2012-11-12 Published:2012-11-12

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摘要： 【摘要】 目的 本文探讨了糖尿病腹膜透析（腹透）患者的长期预后，并进一步研究了影响糖尿病腹透患者预后的独立危险因素。 方法 入选2000年1月1日至2009年12月31日期间在上海交通大学医学院附属仁济医院腹透中心开始腹透治疗的所有终末期肾脏病（end-stage renal disease，ESRD）患者。采用Kaplan-Meier法分析患者的生存率、技术生存率和无腹膜炎生存时间，Log-rank法进行显著性检验。采用Cox比例风险模型分析患者死亡的危险因素。 结果 共有598例患者入选本研究，其中糖尿病患者130例（21.7%）。与非糖尿病患者相比，糖尿病患者的年龄较大（63.7±13.3 vs 52.9±17.0，P<0.001），合并心血管疾病（cardiovascular disease，CVD）的比例更高（31.0% vs 13.6%，P<0.001），血清白蛋白（32.4±5.7 vs 35.1±5.3，P<0.001）和蛋白质分解率（normalized protein catabolic rate，nPCR）较低（0.87±0.26 vs 0.96±0.22，P<0.001）。糖尿病腹透患者的1年、2年、3年和5年患者生存率分别为86.1%、73.5%、58.2%和50.9%，低于非糖尿病腹透患者（Log rank 25.40，P<0.001）。分层分析显示在年龄<65岁的患者中，糖尿病腹透患者的生存率显著低于非糖尿病患者（Log rank 13.36，P<0.001）；年龄≥65岁的患者中，糖尿病与非糖尿病腹透患者的生存率相似（Log rank 0.723，P=0.395）。糖尿病腹透患者的技术生存率和无腹膜炎生存时间均与非糖尿病腹透患者相似（P>0.05）。老龄（HR 1.05 95%CI 1.00-1.08，P=0.019），低血清白蛋白（HR 0.91 95%CI 0.83-1.00，P=0.041）和CVD合并症（HR 4.49 95%CI 1.94-10.41，P<0.001）是影响糖尿病腹透患者生存的独立危险因素。 结论 糖尿病腹透患者的长期生存率低于非糖尿病患者，但技术生存率及无腹膜炎生存时间与非糖尿病患者相似，提示腹透是糖尿病ESRD患者适用的替代治疗方法之一。老龄、低血清白蛋白和CVD合并症是影响糖尿病腹透患者生存的独立危险因素。

Abstract: 【Abstract】 Objective To study the long-term patient and technique survival and analyze the predictors of mortality in diabetic patients receiving peritoneal dialysis (PD). Methods This study included all end-stage renal disease (ESRD) patients who started on PD between 1 January 2000 and 31 December 2009 in Renji Hospital, Shanghai Jiao Tong University school of Medicine. Survival probabilities were studied with Kaplan-Meier method and multivariate Cox proportional hazards models were used to assess the predictors of survival. Results A total of 598 patients were enrolled. Among them, 130 patients (21.7%) were diabetics. Compared with non-diabetic patients, diabetics were older (63.7±13.3 vs 52.9±17.0, P<0.001), had more instances of cardiovascular disease (CVD) (31.0% vs 13.6%,P<0.001), lower serum albumin (32.4±5.7 vs 35.1±5.3,P<0.001) and normalized protein catabolic rate (nPCR) ( 0.87±0.26 vs 0.96±0.22,P <0.001). The 1-,2-,3- and 5-year patient survival rates were 86.1%, 73.5%, 58.2% and 50.9% in diabetics, respectively. Patient survival was significantly lower in diabetic patients when compared to non-diabetics (Log rank 25.40, P<0.001). Stratified analysis showed that diabetic patients had significant inferior survival than non-diabetics in patients younger than 65 yrs (Log rank 13.36,P <0.001), while patient survival was similar in diabetics and non-diabetics when they were aged 65 or older (Log rank 0.723, P =0.395). The technique survival and peritonitis-free survival were similar in both patients (P>0.05). Advanced age (HR 1.05 95%CI 1.00-1.08, P =0.019), lower serum albumin (HR 0.91 95%CI 0.83-1.00, P=0.041) and CVD comorbidity (HR 4.49 95%CI 1.94-10.41, P<0.001) were the significant factors that independently predicted outcome in diabetic patients on PD. Conclusions Long-term patient survival for diabetic PD patients was worse than that of non-diabetics, but technique survival and peritonitis-free survival were comparable. PD remains a viable modality of renal replacement therapy for diabetic ESRD patients. Advanced age, lower serum albumin and CVD comorbidity were predictors of mortality in diabetic PD patients.