老年腹膜透析患者合并营养不良、炎症及心血管疾病对预后的影响分析

Impact of malnutrition, inflammation and cardiovascular diseases on prognosis of elder peritoneal dialysis patients

目的研究老年腹膜透析患者营养不良-炎症-心血管疾病(动脉粥样硬化)综合征(MIA综合征)的发生情况,探讨其与预后的关系。方法横断面调查:于2006年1～12月对入院的50例持续性不卧床腹膜透析(CAPD)患者进行营养状况、炎症状态及心血管并发症进行调查。根据年龄分为A组(≥65岁)和B组(<65岁),其中A组根据是否合并MIA综合征分为A1组(合并MIA综合征)及A2组(不合并MIA综合征)。对这组患者随访1年,记录生存和转归情况,以及退出透析和死亡的原因。采用Kaplan-Meier法,Log-Rank检验进行生存分析。结果经过12个月的随访,50例CAPD患者中有10例(20%)死亡,2例(4%)拔管改血液透析治疗,1例(2%)失访,37例(74%)继续在我院腹膜透析治疗。A组患者平均生存时间显著低于B组(P<0.05)。总营养不良发生率为64%,血CRP超过正常值(8.2mg/L)的发生率为32%,心血管疾病(心力衰竭、冠心病、陈旧性脑梗死、外周血管硬化)的发生率为58%。A组腹膜透析患者的营养不良(75%vs44.4%)及心血管疾病(68.8%vs38.9%)的发生率均显著高于B组(P<0.05)。A组患者CRP水平(7.6±15.2)mg/L显著高于B组(2.4±3.9)mg/L(P<0.01)。MIA综合征的发生率为22%,其中A组11例(34.3%),B组0例。生存分析显示,A1组生存率显著低于A2组及B组(P<0.01),而A2组与B组生存率无统计学意义(P>0.05)。结论老年腹膜透析患者营养不良、炎症及心血管疾病的发生率皆高于年轻患者,MIA综合征是老年腹膜透析患者生存率逊于年轻患者的主要原因,应重视老年腹膜透析患者MIA综合征的诊治。

Objective To investigate the impact of malnutrition, inflammation and cardiovascular diseases on the prognosis of elder peritoneal dialysis patients. Methods A cross-sectional study was performed in 50 clinically stable continuous ambulatory peritoneal dialysis （CAPD） patients. Their nutritional status, chronic inflammation and cardiovascular diseases were evaluated. They were divided into two age groups, group A （≥65 years） and group B （〈65 years）. In group A, patients complicated with malnutrition, inflammation and cardiovascular diseases （arthrosclerosis） （MIA syndrome） were further assigned in group A1, and those without MIA syndrome in group A2. Patients were followed up for 12 months. Results During the 12-month follow-up period, 10 （20%） patients died, and 2 patients （4%） changed to hemodialysis. The follow-up was lost in 1 patient （2%）, and CAPD was continued in our hospital in 37 patients （74%）. The mean survival rate was higher in group B than in group A. Malnutrition （SGA 2 to 3） was found in 64% patients, and C-reactive protein （CRP） higher than normal （8.2 mg/l） indicating inflammation status was detected in 32% patients. Cardiovascular diseases including chronic heart failure, coronary heart disease, cerebral infarction sequelae and peripheral vascular sclerosis were found in 58% patients. The prevalence of malnutrition was 75% in group A and 44.4% in group B, and that of cardiovascular diseases was 68.8% in group A and 38.9% in group B （P〈0.05）. Serum CRP was 7.6 ＋ 15.2 mg/L in group A and 2.4 ~ 3.grog/ L in group B （P〈0.01）. MIA syndrome was identified in 22% patients, of whom all were in group A. The survival rate was lower in group A1 than in groups A2 and B （P〈0.01）, but was similar between group A2 and group B （P〉0.05）. Conclusion Malnutrition, inflammation and cardiovascular diseases were frequently seen in CAPD of elder patients. MIA syndrome was the principal factor leading to the lower survival rate in CAPD of elder patients than in CAPD of younger patients. Therefore, diagnosis and treatment of MIA syndrome, especially in CAPD of elder patients, should be emphasized.