腹膜透析患者体重指数与预后的关系

Effect of Body-mass Index on Survival in Peritoneal Dialysis Patients

目的初步探讨体重指数(BMI)对腹膜透析(PD)患者预后的影响。方法119例1999年1月起始行PD治疗患者,按BMI分为低体重组(BMI<20kg/m2)、正常体重组(20≤BMI<25kg/m2)及超重肥胖组(BMI≥25kg/m2)。采集这些患者的年龄、性别、RRF、Kt/V、血清白蛋白(SA)、Hb、CRP、心血管并发症以及转归等,并进行回顾性分析。结果与正常体重的PD患者相比,低体重者死亡率较高(42.11%对21.67%,P<0.05),而超重肥胖患者预后更差(52.5%对21.67%,P<0.01)。超重肥胖的PD患者心血管并发症的死亡率明显高于正常体重者(P<0.01)。Pearson相关分析发现,这些PD患者的BMI与其CRP(r=0.79,P<0.01),SA(r=0.58,P<0.01),Hb(r=0.32,P<0.05)呈正相关,而与其Kt/V(r=-0.36,P<0.05)负相关。Cox比例风险模型显示,BMI≥25kg/m2与PD患者死亡率独立相关(风险比例,1.31;95%可信限,1.20￣1.54;P<0.05)。结论低体重、尤其是超重肥胖PD患者预后不佳,BMI≥25kg/m2是值得关注的死亡危险因素。

Objective To investigate the effect of body-mass index (BMI) on survival in peritoneal dialysis (PD) patients. Methods Retrospective study of 119 patients initiating PD treatment since 1999.1,the patients were classified as underweight (BMI <20Kg/m2), normal weight (20≤BMI<25Kg/m2), overweight-obese (BM I≥25Kg/m2). The data of patient's age, gender, RRF, Kt/V, hemoglobin(Hb), albumin (Alb), CRP, cardiovascular complications and survival were collected. Results Compared to those with normal BMI, the underweight and overweight-obese groups had higher mortality rates (42.11% vs. 21.67%, 52.5% vs. 21.67%;P<0.05, P<0.01, respectively),with a greater proportion of cardiovascular deaths in the overweight-obese group (P< 0.01). BMI was positively correlated with CRP (r=0.79,P<0.01), Alb (r=0.58,P<0 .01),and Hb (r=0.32,P<0.05),negatively correlated with Kt/V (r=-0.36, P<0.05) .With Cox proportional hazards analysis, BMI≥25Kg/m2 was independently associated with death during PD treatments (hazard ratio, 1.31; 95% CI, 1.20-1.54; P<0.05). Conclusions Underweight and particularly overweight-obese PD patients had poorer survival. BMI above normal was a significant risk factor for mortality rate in PD patients.