中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (2): 64-67.doi: 10.3969/j.issn.1671-4091.2012.01.00

• 临床研究 • 上一篇    下一篇

合并症与腹膜透析患者炎症营养状况及预后关系的探讨

周晓玲 韩庆烽 史均宝   

  1. 北京大学第三医院肾脏内科
  • 收稿日期:2011-09-02 修回日期:1900-01-01 出版日期:2012-02-12 发布日期:2012-02-12

The effects of comorbid conditions on inflammation, nutritional status and outcomes in peritoneal dialysis patients

ZHOU Xiao-ling1,2 , HAN Qing-feng1, SHI Junbo1, NIE Jiandong1, SUN Linghua   

  • Received:2011-09-02 Revised:1900-01-01 Online:2012-02-12 Published:2012-02-12

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摘要： 【摘要】目的 探讨合并症与腹膜透析患者炎症、营养状况以及预后的关系。方法 腹膜透析患者202例人，记录患者进入腹膜透析时和腹膜透析后合并症发生状况以及截止至2010年8月31日前的转归。使用Charlson合并症指数(charlson comorbidity index， CCI)并把患者分为无合并症组、低合并症组和高合并症组，分析比较3组患者的炎症状况、营养水平以及转归情况。结果 低合并症组和高合并症组与无合并症组相比主观综合性营养评估法（SGA）评估的营养不良发生率、血超敏C反应蛋白（hsCRP）水平均显著增加(χ2=17.196，50.230，均P＜0.05)，血白蛋白、瘦体重（LBM）、瘦体重百分比（%LBM）、标准化蛋白质相当总氮表现率(nPNA）均显著降低(F=12.034，6.325，12.505，6.230，均P＜0.05)。Kaplan-Meier分析显示，高合并症组和低合并症组患者的死亡率显著高于无合并症组(χ2=37.048 P＜0.05)。Cox多元回归分析显示，CCI、年龄、SGA、%LBM是影响患者预后的独立危险因素(χ2=9.872，5.836，7.816，15.051，均P＜0.05)。结论 存在合并症的腹膜透析患者在透析过程中可能伴有更多的炎症状态和营养不良，且预后较差；合并症指数可以预测腹膜透析患者的预后。

Abstract: 【Abstract】Objective To investigate the impact of comorbid conditions on inflammation, nutritional status and outcomes in peritoneal dialysis patients. Method A total 202 peritoneal dialysis patients were studied. Pre-dialysis and post-dialysis comorbid and their outcomes were recorded. Patients were then grouped into high comorbid group, low comorbid group and non comorbid group based on the Charlson Comorbidity Index (CCI). Inflammation, nutritional status and outcomes were compared among the groups.  Result Patients with higher CCI score showed worse malnutrition condition evaluated by SGA, lower serum albumin level, and higher serum CRP (P＜0.05). Kaplan-Meier survival analysis revealed a significant difference in cumulative survival rate among the 3 groups, and the cumulative survival rates were lower in CCI high group and CCI low group than in CCI zero group (χ2=37.048, P＜0.05). Cox regression analysis revealed that CCI, age, SGA and percentage of LBM were independent prognostic indicators (χ2=9.872, 5.836, 7.816 and 15.051, respectively, P＜0.05).  Conclusion Peritoneal dialysis patients with comorbid conditions may accompany with systemic inflammation and malnutrition during peritoneal dialysis, which may explain the increased mortality.

Key words: Peritoneal dialysis, ,Comorbidity, ,Charlson Comorbidity Index, Inflammation, Malnutrition, Survival