本文選題：腹膜透析　切入點(diǎn)：腹膜轉(zhuǎn)運(yùn)特性　出處：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:傳統(tǒng)觀點(diǎn)認(rèn)為腹膜小分子溶質(zhì)高轉(zhuǎn)運(yùn)是腹透患者的死亡率及技術(shù)失敗率的重要預(yù)測因子,而腹透患者尤其是基礎(chǔ)腹膜高轉(zhuǎn)運(yùn)患者的預(yù)后存在差異,且隨著透析時間的延長腹膜轉(zhuǎn)運(yùn)特性會發(fā)生改變。目的:本研究通過回顧性分析維持性腹膜透析患者的基線腹膜轉(zhuǎn)運(yùn)特性及在透析過程中的變化趨勢,評估其對腹透患者預(yù)后的影響;進(jìn)一步分析基線腹膜轉(zhuǎn)運(yùn)特性為高轉(zhuǎn)運(yùn)的維持性腹膜透析患者的預(yù)后差異,并評估影響其預(yù)后的相關(guān)因素。方法:1.采用Kaplan-Meier生存分析比較4組患者的生存率、技術(shù)生存率。隨訪復(fù)查入選2006年9月11日至2014年10月30日在本院開始維持性腹透且資料完整患者586例。所有入選患者在腹膜透析開始6個月內(nèi)行基礎(chǔ)腹膜平衡試驗,并規(guī)律復(fù)查。根據(jù)基礎(chǔ)透出液/血漿肌酐濃度比值(D/Pcr)將患者分為4組,0.82～1.03為高轉(zhuǎn)運(yùn)組(H),0.65～0.81為高平均轉(zhuǎn)運(yùn)組(HA),0.50～0.64為低平均轉(zhuǎn)運(yùn)組(LA),0.34～0.49為低轉(zhuǎn)運(yùn)組(L)。D/Pcr值將患者腹膜轉(zhuǎn)運(yùn)特性同上分組,并與相應(yīng)的基線腹膜轉(zhuǎn)運(yùn)特性分組相比較,依據(jù)變化趨勢分為增高組、降低組和不變組,Kaplan-Meier生存分析評估不同轉(zhuǎn)運(yùn)特性變化患者的預(yù)后。2.亞組分析基礎(chǔ)腹膜轉(zhuǎn)運(yùn)特性為較高轉(zhuǎn)運(yùn)(D/Pcr≥0.65)的患者290例,根據(jù)隨訪截止終點(diǎn)患者生存及技術(shù)生存進(jìn)行分組,比較兩組間相關(guān)指標(biāo)的差異,COX生存回歸分析預(yù)后不良的相關(guān)影響因素。結(jié)果:1.L組67人,LA組229人,HA組252人,H組38人,高轉(zhuǎn)運(yùn)組患者累積生存率顯著低于低轉(zhuǎn)運(yùn)組(P=0.04)、低平均轉(zhuǎn)運(yùn)組(P0.01)、高平均轉(zhuǎn)運(yùn)組(P=0.04),其余各組間無顯著差異;技術(shù)生存率各組間無顯著差異。透析時年齡≥65歲(HR=2.499)、隨訪時營養(yǎng)不良(HR=3.144)、隨訪超濾量≤400 ml/d(HR=1.863)、超敏C反應(yīng)蛋白水平≥10 mg/L(HR=4.526)是患者死亡的獨(dú)立危險因素。2.隨訪復(fù)查D/Pcr值增高組127人、降低組101人、不變組179人;3組間患者生存率差異無統(tǒng)計學(xué)意義(P=0.064)。但在基礎(chǔ)轉(zhuǎn)運(yùn)率較高(D/Pcr≥0.65)的患者中,復(fù)查D/Pcr下降組的生存率低于增高組(P=0.03)及不變組(P=0.05)。3.對于基礎(chǔ)轉(zhuǎn)運(yùn)率較高(D/Pcr0.65)的患者進(jìn)行亞組分析,較高轉(zhuǎn)運(yùn)組共計290人,平均隨訪41.5(3～116)月,死亡41人,轉(zhuǎn)血液透析50人。患者生存率為85.9%,COX回歸分析顯示高齡(HR=3.368)、Charlson合并癥指數(shù)(CCI指數(shù))高(HR=2.478)、隨訪期超濾下降(HR=6.750)、隨訪期營養(yǎng)不良(HR=5.255)、持續(xù)非臥床腹膜透析(CAPD)模式(HR=4.336)是基礎(chǔ)腹膜高轉(zhuǎn)運(yùn)患者死亡的獨(dú)立危險因素;技術(shù)生存率為68.6%,COX回歸分析顯示高齡(HR=2.552)、隨訪期營養(yǎng)不良(HR=2.179)、隨訪期超濾下降(HR=2.234)是患者退出腹膜透析的獨(dú)立危險因素。結(jié)論:基礎(chǔ)腹膜高轉(zhuǎn)運(yùn)患者生存率較低,特別是隨訪期腹膜轉(zhuǎn)運(yùn)率下降者患者生存率更差。關(guān)注腹膜高轉(zhuǎn)運(yùn)患者預(yù)后不良的獨(dú)立危險因素如超濾下降、營養(yǎng)不良及合并癥的預(yù)防與治療,采用合適的透析治療模式,可改善其生存率。
[Abstract]:Background: the traditional view is that high transport of small molecular solute in peritoneal cavity is an important predictor of mortality and failure rate of technique in patients with peritoneal dialysis, and the prognosis of patients with peritoneal dialysis, especially those with high transport of basic peritoneum, is different. With the prolongation of dialysis time, the peritoneal transport characteristics will change. Objective: to analyze the baseline peritoneal transport characteristics and the trend of peritoneal transport during dialysis in patients with maintenance peritoneal dialysis (MPD). To assess its impact on the prognosis of patients with peritoneal dialysis, and to further analyze the differences in prognosis in patients with maintenance peritoneal dialysis whose baseline peritoneal transport is high transport. Methods 1. Kaplan-Meier survival analysis was used to compare the survival rate of the four groups. Technique survival rate. 586 patients with complete data from 11 September 2006 to 30 October 2014 were enrolled in this study. All patients underwent the basic peritoneal balance test within 6 months of the beginning of peritoneal dialysis. The patients were divided into 4 groups according to the ratio of basic permeable fluid / plasma creatinine concentration (D / Pcr). The patients were divided into 4 groups. The patients were divided into 4 groups: high transport group: high transport group: high average transport group: high average transport group: high average transport group: high average transport group: high average transport group: low average transport group: low average transport group: low transport group: Ln = 0.340.49. Compared with the corresponding baseline peritoneal transport characteristics, the patients were divided into two groups according to the trend of change. Kaplan-Meier survival analysis was used to evaluate the prognosis of patients with different transport characteristics. 2. The subgroup analyzed 290 patients whose basic peritoneal transport characteristics were higher than 0.65). The patients were divided into two groups according to survival and technical survival at the end of follow-up. The correlation factors of poor prognosis in Cox regression analysis were compared between the two groups. Results (1) 67 patients in L group, 229 patients in LA group, 252 patients in HA group, 38 patients in H group. The cumulative survival rate in the high transport group was significantly lower than that in the low transport group (P 0.04), the low average transport group (P 0.01) and the high average transport group (P < 0.04). There was no significant difference among the other groups. There was no significant difference in survival rate among the groups. Age 鈮，

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