腹膜透析患者初始高腹膜转运状态危险因素分析
Risk factors analysis of initial high peritoneal solute transport status in peritoneal dialysis patients

目的 · 探讨不同转运状态的新入腹膜透析（PD）患者的临床特点，对腹膜高转运状态的危险因素进行分析。方法 · 对 2007 年 1 月—2015 年 10 月连续新入 PD 患者（455 例）的临床资料进行回顾性分析。根据患者首次标准腹膜平衡实验（sPET）结果参考 ISPD 指南将患者分为H/HA 组（4h D/Pcr ≥ 0.65）与L/LA 组（4h D/Pcr<0.65），比较2 组临床及生化参数的差异；建立Logistic 回 归模型，分析高腹膜转运状态的危险因素。结果 · 共入选372 例新入PD 患者，L/LA 组和H/HA 组患者分别为264 例（71.2%）和 108 例（28.8%）。相比 L/LA 组患者，H/HA 组男性患者比例较高（63.0% vs 50.8%，P=0.03），残余肾功能较低［（4.26±2.77） mL/min vs （5.79±4.53） mL/min，P<0.01）］，血清白蛋白水平较低［（29.34±6.89） g/L vs (32.08±5.86) g/L，P=0.00］，糖尿病肾病比例较高 （19.4% vs 9.5%，P=0.00）。 Logistic 回归分析结果显示：低白蛋白血症（OR=0.96，95% CI 0.28 ～ 0.99；P=0.02），男性（OR=1.92， 95% CI 1.19 ～ 3.12；P=0.00），糖尿病肾病（OR=2.52，95% CI 1.26 ～ 5.05；P=0.00）及低残肾功能（OR=0.90，95% CI 0.83 ～ 0.96； P=0.00）是腹膜高转运状态的危险因素。进一步分析发现，与正常血白蛋白组相比，低血白蛋白组患者高敏C 反应蛋白（hsCRP） 水平更高（1.69 mg/L vs 0.69 mg/L，P=0.00）。 结论 · 纳入患者初始腹透时以低及低平均转运状态为主。低白蛋白血症、男性、糖尿 病肾病及低残余肾功能是腹膜高转运状态的危险因素。慢性炎症状态可能部分解释了PD 患者低白蛋白血症与腹膜高转运状态的相 关性。
：Objective · To investigate the clinical characteristics of initial peritoneal dialysis (PD) patients with different peritoneal transport status, and analyze risk factors of high peritoneal transport status in PD patients. Methods · A total of 455 consecutive PD patients newly starting PD between January 2007 to October 2015 were retrospectively analyzed. According to the results of the first sPET, patients were divided into H/HA (4h D/Pcr≥0.65) and L/ LA (4h D/Pcr<0.65) groups. Clinical and biochemical characteristics between the two groups were compared. Multivariate logistic regression model was established to investigate risk factors of higher peritoneal transport status of incident PD patients. Results · The study included 372 incident PD patients. The L/LA group and H/HA group had 264 cases (71.2%) and 108 cases (28.8%) respectively. The H/HA group had higher proportion of male patients (63.0% vs 50.8%, P=0.03), lower residual renal function [RRF, (4.26±2.77) mL/min vs (5.79±4.53) mL/min, P<0.01], lower serum albumin level [(29.34±6.89) g/L vs (32.08±5.86) g/L, P=0.00], and more frequent diabetic nephropathy (19.4% vs 9.5%, P=0.00), compared with L/LA group. Univariate and multivariate logistic regression analysis showed that higher peritoneal transport status was associated with lower serum albumin level (OR=0.96, 95% CI 0.28-0.99; P=0.02), male (OR=1.92, 95% CI 1.19-3.12; P=0.00), presence of diabetic nephropathy (OR=2.52, 95% CI 1.26-5.05; P=0.00) and lower residual renal function (OR=0.90, 95% CI 0.83-0.96; P=0.00). The level of hsCRP in patients with hypoalbuminemia was higher than that in patients with normal albumin level (1.69 mg/L vs 0.69 mg/L, P=0.00).