發(fā)布時(shí)間：2018-05-24 17:39

  本文選題：腹膜透析 + 癌抗原　； 參考：《上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2016年03期

【摘要】：目的探討腹膜透析(腹透)患者透出液中癌抗原125(CA125)水平變化對(duì)患者預(yù)后的影響。方法入選2005年1月—2009年12月間在上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院腹透中心行持續(xù)性非臥床腹透且透析12個(gè)月以上的資料完整的患者。入選患者在開(kāi)始腹透時(shí)測(cè)定透出液中CA125(dCA125)濃度,腹透12個(gè)月后復(fù)測(cè)dCA125;根據(jù)dCA125變化的中位數(shù),將患者分為dCA125穩(wěn)定組和dCA125升高組;所有患者隨訪至死亡、退出腹透、轉(zhuǎn)其他中心、失訪或至研究終止日期(2014年6月30日)。采用Kaplan-Meier法比較兩組患者生存率、技術(shù)生存率以及無(wú)腹膜炎生存時(shí)間,采用Cox比例風(fēng)險(xiǎn)模型分析與患者預(yù)后相關(guān)的獨(dú)立危險(xiǎn)因素。結(jié)果共有111例患者入選本研究,平均年齡(53.5±14.7)歲,男性患者53例(47.7%),27例(24.3%)患者合并糖尿病。兩組患者的基線人口學(xué)資料、臨床指標(biāo)等差異均無(wú)統(tǒng)計(jì)學(xué)意義。研究期間,dCA125穩(wěn)定組(n=55)患者共發(fā)生73次腹膜炎,平均腹膜炎發(fā)生率為1次/50.0病人月;dCA125升高組(n=56)患者共發(fā)生44次腹膜炎,平均腹膜炎發(fā)生率為1次/75.3病人月。dCA125穩(wěn)定組患者的無(wú)腹膜炎生存時(shí)間明顯短于dCA125升高組患者(log-rank 6.133,P=0.013)。兩組患者的長(zhǎng)期生存率(log-rank 2.108,P=0.147)和技術(shù)生存率(log-rank 0.108,P=0.743)差異均無(wú)統(tǒng)計(jì)學(xué)意義。Cox比例風(fēng)險(xiǎn)模型分析顯示:dCA125升高(HR 0.538,95%CI 0.296~0.979,P=0.03)是患者發(fā)生腹膜炎的獨(dú)立保護(hù)因素。結(jié)論腹透患者dCA125升高是發(fā)生腹膜炎的保護(hù)因素,而dCA125的變化與患者長(zhǎng)期生存率、技術(shù)生存率無(wú)關(guān)。檢測(cè)dCA125水平的變化可能可預(yù)測(cè)腹透患者腹膜炎的發(fā)生。
[Abstract]:Objective to investigate the effect of cancer antigen 125 CA 125 in peritoneal dialysis (peritoneal dialysis) on prognosis. Methods from January 2005 to December 2009, patients who underwent continuous ambulatory peritoneal dialysis at Renji Hospital affiliated to Shanghai Jiaotong University Medical College and who had been undergoing dialysis for more than 12 months were enrolled. The patients were divided into stable dCA125 group and elevated dCA125 group according to the median of dCA125 changes. All the patients were followed up until death, exited peritoneal dialysis, and transferred to other centers. Lost visit or to the end of the study date (30 June 2014). The survival rate, technique survival rate and peritonitis survival time of the two groups were compared by Kaplan-Meier method. The independent risk factors associated with prognosis were analyzed by Cox proportional risk model. Results A total of 111 patients were enrolled in this study, with an average age of 53.5 鹵14.7 years. There were 53 male patients with diabetes mellitus. There was no significant difference in baseline demographic data and clinical indexes between the two groups. During the study, 73 peritonitis occurred in patients with stable dCA125) and 44 peritonitis occurred in patients with elevated dCA125 per month (mean incidence of peritonitis was 1 / 50.0 patients per month). The mean peritonitis survival time of the stable group was significantly shorter than that of the patients with elevated dCA125. The mean incidence of peritonitis was 6.133.The survival time of the stable group was significantly shorter than that of the patients with elevated dCA125. The long-term survival rate (log-rank 2.108) and the technical survival rate (log-rank 0.108 P0.743) were not significantly different between the two groups. The Cox proportional risk model analysis showed that the increase of HR 0.53895 CI 0.296 / 0.979P0.03) was an independent protective factor for peritonitis. Conclusion the elevation of dCA125 is the protective factor of peritonitis in peritoneal dialysis patients, but the change of dCA125 is not related to long term survival rate and technical survival rate. Changes in dCA125 levels may predict peritonitis in patients with peritoneal dialysis.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院腎臟科上海市腹膜透析研究中心;
【分類號(hào)】：R692.5

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