腹膜透析患者不同初始腹膜转运功能的生存预后及影响因素
Survival Prognosis and Influencing Factors of Different Initial Peritoneal Transport Function in Patients with Peritoneal Dialysis
DOI: 10.12677/acm.2024.1441038, PDF,   
作者: 张静静：锦州医科大学研究生院，辽宁 锦州；王晓青, 蔄瑜琳*：临沂市人民医院肾内科，山东 临沂
关键词: 腹膜透析；腹膜转运功能；高转运；生存分析；Peritoneal Dialysis； Peritoneal Transport Function； High Transport； Survival Analysis
摘要: 目的：回顾性分析腹膜透析患者不同初始腹膜转运功能的临床特点及生存预后情况，探讨其影响因素。方法：纳入2019年1月1日~2023年1月31日在临沂市人民医院行腹膜透析置管术267例患者，根据腹膜平衡实验结果分为高转运组、高平均转运组、低平均转运组、低转运组，采用Kaplan-Meier法分析不同初始腹膜转运功能对患者生存率及技术生存率影响，Logistic回归分析初始腹膜转运功能的影响因素，COX回归分析影响患者生存的危险因素。结果：四组患者在血红蛋白、白蛋白、尿酸、超滤量存在统计学差异(P < 0.05)。Kaplan-Meier分析显示：高转运组患者的累计生存率低于高平均转运组(P = 0.024)、低平均转运组(P = 0.011)、低转运组(P = 0.009)。各组间的技术生存率差异无统计学差异(P = 0.088)。Logistic回归显示：男性(OR = 2.641)、白蛋白 ≤ 30 g/L (OR = 3.452)、尿酸(OR = 1.005)、血红蛋白 ≤ 90 g/L (OR = 1.952)是初始腹膜高转运状态的决定因素。COX多因素回归结果显示：年龄 ≥ 60 (HR = 2.034)，有无糖尿病(HR = 2.331)，既往有无腹膜炎(HR = 2.312)、白蛋白 ≤ 30 g/L (HR = 2.546)，超滤量 ≤ 100 ml (HR = 3.277)是导致患者全因死亡的独立危险因素。结论：本中心初始腹膜高转运患者生存率低，但高转运转态并非影响死亡的独立危险因素，综合考虑患者个体差异及指标变化，将为制定适当的透析方案提供更有利的依据。
Abstract: Objective: This retrospective study aims to analyze the clinical characteristics and survival prognosis of patients undergoing peritoneal dialysis with varying initial peritoneal transport functions, as well as investigate the influencing factors. Methods: A total of 267 patients who underwent peritoneal dialysis catheterization at Linyi People’s Hospital from January 1, 2019 to January 31, 2023 were included in this study. Based on the results of the peritioneal equilibration test (PET), patients were stratified into four groups according to their initial peritoneal transport function: high transport group, high mean transport group, low mean transport group, and low transport group. The impact of different initial peritoneal transport functions on patient survival rate was analyzed using the Kaplan-Meier method, while logistic regression analysis was conducted to identify factors influencing initial peritoneal transport. Multivariate COX regression analysis was performed to determine risk factors affecting patient survival rates. Results: Statistically significant differences were observed among these four groups regarding hemoglobin, albumin, uricacid, and ultrafiltration (P < 0.05). Kaplan-Meier analysis demonstrated that the cumulative survival rate of patients in the high transport group was significantly lower compared to those in the high average transport group (P = 0.024), low average transport group (P = 0.011), and low transport group (P = 0.009). The difference in technical survival between groups was not statistically different (P = 0.088). Logistic regression analysis revealed that being male (OR = 2.641), having albumin levels ≤ 30 g/L (OR = 3.452), elevated uric acid levels (OR = 1.005), and hemoglobin levels ≤ 90 g/L (OR = 1.952) were identified as significant determinants for the initial state of high peritoneal transport. Multivariate Cox regression analyses revealed that age ≥ 60 (HR = 2.034), presence or absence of diabetes (HR = 2.331), history of peritonitis (HR = 2.312), albumin ≤ 30 g/L (HR = 2.546) and ultrafiltration volume ≤ 100 ml (HR = 3.277) were independent risk factors associated with all-cause mortality in patients. Conclusions: The survival rate of patients with initial high peritoneal transport is relatively low in our center; however, high peritoneal transport status does not emerge as an independent risk factor for mortality. Taking into account individual variations and changes in indices among patients will provide a more favorable foundation for devising appropriate dialysis programs.
文章引用：张静静, 王晓青, 蔄瑜琳. 腹膜透析患者不同初始腹膜转运功能的生存预后及影响因素[J]. 临床医学进展, 2024, 14(4): 414-421. https://doi.org/10.12677/acm.2024.1441038

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