锥削度指数与腹膜透析患者预后及其相关因素的关系

Association between conicity index and survival in peritoneal dialysis patients

[目的]研究锥削度指数(CI)与腹膜透析患者预后及其相关因素的关系.[方法]回顾性分析2003年9月至2004年5月接受营养评估的行持续性不卧床腹膜透析(CAPD)治疗的130例终末期肾脏病(ESRD)患者的临床资料,连续观察108个月,截至2012年7月.将患者按百分位数法分为低CI组(<1.217)、正常CI组(1.217~1.332)及高CI组(>1.332).用SGA评估定义蛋白-能量消耗(PEW)情况;用血清肌酐间接评估肌肉质量情况.采用Kaplan-Meier法评估分析比较组间生存率的差异;Cox比例风险模型分析CI与预后的关系,评估全因死亡率及心血管疾病死亡率.[结果]130例患者平均CI为1.27±0.13(0.50~1.54),高CI组中重度营养不良者多见(13例,43.3%,P<0.001);高CI组与其他2组相比较,血清肌酐值(mg/L)偏低(86±39,114±40,96±33,P=0.007);年龄(岁)偏大(59±9,51±11,44±11,P<0.001);高CI组合并有糖尿病者较多(18例,60.0%).高CI组与另2组相比较有较高的aCCI评分(4.3±1.5,2.7±1.0,3.4±1.4,P<0.001)、腰围(cm)(93.1±5.5,75.1±12.4,86.1±6.7,P<0.001)及腰臀比(0.95±0.07,0.87±0.06,0.92±0.05,P<0.001).Kaplan-Meier生存曲线分析显示,高CI组的生存率明显低于低CI组(23.3%,53.3%,P=0.01);校正了性别、腹膜炎发病次数、aCCI,SGA,BMI、血红蛋白、血浆白蛋白等因素后,Cox比例风险模型结果显示高CI组的全因死亡率(HR=14.98,95%CI:2.73~82.24)及心血管疾病死亡率(HR=19.82,95%CI:2.13~184.2)明显增高,提示高CI为全因死亡率和心血管疾病死亡率的独立危险因素.[结论]腹部脂肪沉积增多可能是影响腹膜透析患者死亡的危险因素;高CI的腹膜透析患者中营养不良者较多见,血肌酐偏低,可能与PEW相关.

OBJECTIVE To elaluate the association between conicity index and survial in peritoneal dialysis patients.METHODS This retrospective study was performed on ESRD patients on CAPD who had been followed up at the outpatient peritoneal dialysis clinic.The prevalence of AO in 130 peritoneal dialysis patients was assessed in a cross-section manner and followed up for 108 months in a single center.Patients were classified according to the percentile of CI as low CI group(<1.217),middle CI group(1.217-1.332),high CI group(>1.332).Protein energy expenditure was evaluated SGA,S-creatinine was putatively a surrogate marker of muscle mass.The overall patient survival was estimated using the Kaplan-Meier method;Mortality was analyzed using the multivariate Cox’s proportional hazard model.RESULTS Mean CI was 1.27±0.13(range 0.50-1.54).In high CI group,13(43.3%)were severely malnourished and reduced levels of S-creatinine compared with low CI group and middle CI group.S-creatinine(mg/L)(86±39,114±40,96±33,P=0.007);the average age(59±9,51±11,44±11,P<0.001),patients with diabetes melitus(18 cases,60.0%);aCCI score(4.3±1.5,2.7±1.0,3.4±1.4,P<0.001);waist circumference(cm)(93.1±5.5,75.1±12.4,86.1±6.7,P<0.001);WHR(0.95±0.07,0.87±0.06,0.92±0.05,P<0.001).Kaplan-Meier analysis revealed that 5 years survival rate was significantly lower in high CI group than in low CI group(23.3%,53.3%,P=0.01).In multivariate analysis adjusted for sex,previous peritonitis rate,aCCI,SGA,BMI,hemoglobin,serum albumin,increased CI was an independent risk factor of all-cause mortality(HR 14.98,95%CI 2.73-82.24)and CVD mortality(HR=19.82,95%CI 2.13-184.2).CONCLUSION Increased CI have poorer outcome in CAPD patients,increased abdominal fat deposition in CAPD patients is linked to PEW.