不同腹膜轉(zhuǎn)運(yùn)特性與腹膜透析患者的預(yù)后關(guān)系研究
發(fā)布時(shí)間：2019-02-25 08:59
【摘要】：研究背景：腹膜透析是終末期腎臟疾病患者替代治療方式之一,在該人群中普遍存在著不同程度的營養(yǎng)不良及微炎癥狀態(tài),影響其生活質(zhì)量及預(yù)后。腹膜轉(zhuǎn)運(yùn)特性是腹膜透析效能的重要影響因素,可能會對CAPD患者的預(yù)后有一定影響。本研究通過分析不同腹膜轉(zhuǎn)運(yùn)特性的CAPD患者血生化、營養(yǎng)、炎癥等指標(biāo)的差異,探討其與預(yù)后之間的關(guān)系,為臨床實(shí)踐提供客觀依據(jù)。研究目的：1.探討不同初始腹膜轉(zhuǎn)運(yùn)特性與腹膜透析患者的血生化、營養(yǎng)、炎癥等相關(guān)指標(biāo)的關(guān)系。2.回顧性研究本中心不同初始腹膜轉(zhuǎn)運(yùn)特性患者的預(yù)后差異。3.分析本中心腹透患者死亡及技術(shù)失敗的獨(dú)立危險(xiǎn)因素。研究方法：選取我院2010年1月至2014年1月期間,接受持續(xù)不臥床式腹膜透析(CAPD)治療至少2年以上的慢性腎衰竭患者為研究對象。評估患者腹膜溶質(zhì)轉(zhuǎn)運(yùn)特性,根據(jù)6個(gè)月內(nèi)PET試驗(yàn)結(jié)果作為患者初始腹膜特性來進(jìn)行分組,即A組為低轉(zhuǎn)運(yùn)組(包含低轉(zhuǎn)運(yùn)及低平均轉(zhuǎn)運(yùn)類型)、B組為高轉(zhuǎn)運(yùn)組(包含高轉(zhuǎn)運(yùn)及高平均轉(zhuǎn)運(yùn)類型)。以開始腹透作為基線,記錄兩組患者的年齡、性別、教育程度、原發(fā)病、BMI、血糖、超濾量等基本信息。篩選我院腹透系統(tǒng)中兩組患者不同時(shí)間段的血生化、營養(yǎng)、炎癥等相關(guān)指標(biāo)及末次隨訪時(shí)間、轉(zhuǎn)歸等數(shù)據(jù)。以患者死亡、轉(zhuǎn)腎移植、轉(zhuǎn)血透及截止2016年1月1日患者仍在腹透隨訪中作為研究終點(diǎn)。研究結(jié)果采用SPSS 22.0軟件進(jìn)行數(shù)據(jù)分析。研究結(jié)果：本研究顯示,符合標(biāo)準(zhǔn)的我中心腹膜透析患者共計(jì)男性253例,女性198例；平均年齡48.2±13.3歲,平均末次隨訪時(shí)間37.0±17.6月；原發(fā)病以慢性腎小球腎炎為主,占65.4%,其次為糖尿病腎病,下一位是高血壓腎病。451例接受CAPD治療的患者中,其中有245例(54.3%)患者繼續(xù)腹膜透析治療,118例(26.2%)患者轉(zhuǎn)腎移植,48例(10.6%)患者改血透治療,40例(8.9%)患者死亡。與高轉(zhuǎn)運(yùn)組患者相比,低轉(zhuǎn)運(yùn)組患者在12月內(nèi)的血肌酐、尿酸水平偏高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。與高轉(zhuǎn)運(yùn)組患者相比,低轉(zhuǎn)運(yùn)組患者在12月內(nèi)的腹膜KTV、腹膜CCR偏低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。與高轉(zhuǎn)運(yùn)組患者相比,6月到36月期間低轉(zhuǎn)運(yùn)組患者炎癥指標(biāo)超敏CRP水平偏低,12月內(nèi)營養(yǎng)指標(biāo)如白蛋白較高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。初始腹膜轉(zhuǎn)運(yùn)特性與患者生存率無明顯統(tǒng)計(jì)學(xué)差異(P0.05),與患者的技術(shù)生存率有統(tǒng)計(jì)學(xué)差異(P0.05)。腹透年齡是腹透患者死亡的獨(dú)立危險(xiǎn)因素(P0.05)。研究結(jié)論：本研究顯示在12月內(nèi),高轉(zhuǎn)運(yùn)組患者的血肌酐、尿酸水平低于低轉(zhuǎn)運(yùn)組；高轉(zhuǎn)運(yùn)組患者的腹膜KT/V、CCR水平高于低轉(zhuǎn)運(yùn)組；高轉(zhuǎn)運(yùn)組患者的營養(yǎng)指標(biāo)如白蛋白12月內(nèi)低于低轉(zhuǎn)運(yùn)組,營養(yǎng)狀況較差；6月到36月期間高轉(zhuǎn)運(yùn)組患者的炎癥指標(biāo)高于低轉(zhuǎn)運(yùn)組,腹膜炎發(fā)生風(fēng)險(xiǎn)較高；不同初始腹膜轉(zhuǎn)運(yùn)特性的患者生存預(yù)后無明顯差異,低轉(zhuǎn)運(yùn)特性患者的技術(shù)生存率較高；腹透年齡是腹透患者死亡的獨(dú)立危險(xiǎn)因素。
[Abstract]:Background: peritoneal dialysis (PD) is one of the alternative therapies for end-stage renal diseases. Malnutrition and microinflammation are common in this population, which affects their quality of life and prognosis. Peritoneal transport is an important factor in the efficacy of peritoneal dialysis, which may have a certain impact on the prognosis of CAPD patients. The purpose of this study was to explore the relationship between blood biochemistry, nutrition and inflammation in patients with CAPD with different peritoneal transport characteristics, and to provide an objective basis for clinical practice. Objective: 1. To explore the relationship between different initial peritoneal transport characteristics and blood biochemical, nutritional, inflammatory and other related indexes in peritoneal dialysis patients. 2. A retrospective study was conducted on the prognosis of patients with different initial peritoneal transport characteristics in the center. 3. The independent risk factors of death and technical failure were analyzed. Methods: patients with chronic renal failure (CRF) who received continuous ambulatory peritoneal dialysis (CAPD) for at least 2 years from January 2010 to January 2014 were selected as the study subjects. To evaluate the peritoneal solute transport characteristics of patients, and group them according to the results of PET test within 6 months as the initial peritoneal characteristics of the patients, that is, group A was a low transport group (including low transport and low average transport types). Group B is high transport group (including high transport and high average transport type). The basic information of age, sex, education, primary disease, BMI, blood glucose and ultrafiltration were recorded. Blood biochemistry, nutrition, inflammation and the last follow-up time and prognosis of the two groups of patients in the abdominal dialysis system of our hospital were selected. Patients with death, renal transplantation, hemodialysis and follow-up of peritoneal dialysis as of January 1, 2016 were the end of the study. The data were analyzed by SPSS 22. 0 software. Results: in this study, 253 male and 198 female peritoneal dialysis patients met the criteria, with an average age of 48.2 鹵13.3 years and an average follow-up time of 37.0 鹵17.6 months. Chronic glomerulonephritis was the main primary disease, accounting for 65.4%, followed by diabetic nephropathy, followed by hypertension nephropathy. 245 (54.3%) of the 451 patients receiving CAPD treatment continued to be treated with peritoneal dialysis. 118 cases (26.2%) were transferred to renal transplantation, 48 cases (10.6%) were converted to hemodialysis, and 40 cases (8.9%) died. Compared with the high transport group, the serum creatinine and uric acid levels in the low transport group were higher than those in the high transport group within 12 months, the difference was statistically significant (P0.05). Compared with the high transport group, the peritoneal KTV, peritoneal CCR in the low transport group was lower in 12 months than that in the high transport group (P0.05). Compared with the patients with high transport, the level of hypersensitive CRP was lower in the low transport group from June to 36 months, and the nutritional index such as albumin was higher in 12 months, the difference was statistically significant (P0.05). There was no significant difference between the initial peritoneal transport characteristics and the survival rate (P0.05), but there was a significant difference between the initial peritoneal transport characteristics and the survival rate of the patients (P0.05). The age of peritoneal dialysis was an independent risk factor for death (P0.05). Conclusion: in this study, the serum creatinine and uric acid levels in high transport group were lower than those in low transport group, the peritoneal KT/V,CCR level in high transport group was higher than that in low transport group within 12 months. The nutritional index of high transport group was lower than that of low transport group within 12 months, and the nutritional status of high transport group was lower than that of low transport group, and the inflammatory index of high transport group was higher than that of low transport group during June to 36 months, and the risk of peritonitis was higher. The survival and prognosis of patients with different initial peritoneal transport characteristics were not significantly different, and the survival rate of patients with low transport characteristics was higher, and the age of peritoneal dialysis was an independent risk factor for the death of patients with peritoneal dialysis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R692.5
本文編號：2430007
[Abstract]:Background: peritoneal dialysis (PD) is one of the alternative therapies for end-stage renal diseases. Malnutrition and microinflammation are common in this population, which affects their quality of life and prognosis. Peritoneal transport is an important factor in the efficacy of peritoneal dialysis, which may have a certain impact on the prognosis of CAPD patients. The purpose of this study was to explore the relationship between blood biochemistry, nutrition and inflammation in patients with CAPD with different peritoneal transport characteristics, and to provide an objective basis for clinical practice. Objective: 1. To explore the relationship between different initial peritoneal transport characteristics and blood biochemical, nutritional, inflammatory and other related indexes in peritoneal dialysis patients. 2. A retrospective study was conducted on the prognosis of patients with different initial peritoneal transport characteristics in the center. 3. The independent risk factors of death and technical failure were analyzed. Methods: patients with chronic renal failure (CRF) who received continuous ambulatory peritoneal dialysis (CAPD) for at least 2 years from January 2010 to January 2014 were selected as the study subjects. To evaluate the peritoneal solute transport characteristics of patients, and group them according to the results of PET test within 6 months as the initial peritoneal characteristics of the patients, that is, group A was a low transport group (including low transport and low average transport types). Group B is high transport group (including high transport and high average transport type). The basic information of age, sex, education, primary disease, BMI, blood glucose and ultrafiltration were recorded. Blood biochemistry, nutrition, inflammation and the last follow-up time and prognosis of the two groups of patients in the abdominal dialysis system of our hospital were selected. Patients with death, renal transplantation, hemodialysis and follow-up of peritoneal dialysis as of January 1, 2016 were the end of the study. The data were analyzed by SPSS 22. 0 software. Results: in this study, 253 male and 198 female peritoneal dialysis patients met the criteria, with an average age of 48.2 鹵13.3 years and an average follow-up time of 37.0 鹵17.6 months. Chronic glomerulonephritis was the main primary disease, accounting for 65.4%, followed by diabetic nephropathy, followed by hypertension nephropathy. 245 (54.3%) of the 451 patients receiving CAPD treatment continued to be treated with peritoneal dialysis. 118 cases (26.2%) were transferred to renal transplantation, 48 cases (10.6%) were converted to hemodialysis, and 40 cases (8.9%) died. Compared with the high transport group, the serum creatinine and uric acid levels in the low transport group were higher than those in the high transport group within 12 months, the difference was statistically significant (P0.05). Compared with the high transport group, the peritoneal KTV, peritoneal CCR in the low transport group was lower in 12 months than that in the high transport group (P0.05). Compared with the patients with high transport, the level of hypersensitive CRP was lower in the low transport group from June to 36 months, and the nutritional index such as albumin was higher in 12 months, the difference was statistically significant (P0.05). There was no significant difference between the initial peritoneal transport characteristics and the survival rate (P0.05), but there was a significant difference between the initial peritoneal transport characteristics and the survival rate of the patients (P0.05). The age of peritoneal dialysis was an independent risk factor for death (P0.05). Conclusion: in this study, the serum creatinine and uric acid levels in high transport group were lower than those in low transport group, the peritoneal KT/V,CCR level in high transport group was higher than that in low transport group within 12 months. The nutritional index of high transport group was lower than that of low transport group within 12 months, and the nutritional status of high transport group was lower than that of low transport group, and the inflammatory index of high transport group was higher than that of low transport group during June to 36 months, and the risk of peritonitis was higher. The survival and prognosis of patients with different initial peritoneal transport characteristics were not significantly different, and the survival rate of patients with low transport characteristics was higher, and the age of peritoneal dialysis was an independent risk factor for the death of patients with peritoneal dialysis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R692.5
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 譚融通;黃莉;李堅(jiān)梅;;103例次持續(xù)性非臥床腹膜透析相關(guān)性腹膜炎的臨床流行病學(xué)研究[J];重慶醫(yī)學(xué);2012年13期
2 孫晶;張焱;張虹;于克洲;王群;王榮;;低鈣透析液對CAPD患者鈣磷代謝的影響[J];中國血液凈化;2009年05期
，本文編號：2430007
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