老年持续不卧床腹膜透析患者中的胃食管反流病发生率及相关因素分析

Prevalence of gastroesophageal reflux disease and related risk factors in elderly patients on continuous ambulatory peritonealdialysis

目的评估老年持续不卧床腹膜透析（CAPD）患者胃食管反流病（GERD）的发生率及探讨可能的相关影响因素。方法采用胃食管反流病问卷（RDQ）对56例腹膜透析患者进行评分，≥12分者考虑胃食管反流病。按年龄分为老年组（年龄≥60岁）和非老年组（年龄〈60岁），比较两组之间在一般临床资料、腹膜透析相关指标、营养指标、钙磷代谢指标、炎症指标以及RDQ分值之间的差异，并评估各指标与RDQ分值之间的相关性。结果老年与非老年CAPD患者在体重指数（BMI）、腹透龄、日透析液量及每周尿素清除指数（Kt／V）方面差异均无统计学意义，老年组每周总肌酐清除率（Ccr）较非老年组患者增高，P=0．031；两组在营养指标、钙磷代谢指标及炎症指标方面差异无统计学意义。按照RDQ诊断的GERD的发生率，老年组为18．52％，非老年组为13．79％，差异无统计学意义；老年组平均RDQ得分为4．07±5．27，非老年组平均RDQ得分为3．90±6．74，差异无统计学意义，P〉0．05。RDQ分值与每日透析液量呈正相关，（r=0．349，P=0．009）。结论老年CAPD患者RDQ总体得分及GERD的发病率高于非老年CAPD患者，差异是否有意义尚需大型临床试验证实。RDQ分值和每日透析液量呈正相关，与其他透析相关凶素的相关性尚需进一步验证。

Objective To evaluate the prevalence of gastroesophageal reflux disease in elderly patients on continuous ambulatory peritoneal dialysis （CAPD） and analyze the correlative factors. Methods 56 CAPD patients with good clinical conditions were inquired about their gastroesophageal reflux symptoms by the same doctor according to reflux disease questionnaire （RDQ）. The senile group involved patients ≥ 60 years old, and the non-senile group involved patients 〈 60 years old. Baseline characteristics, peritoneal dialysis related factors, nutritional indexes, inflammatory index and RDQ score were compared between the two groups. Correlations between RDQ score and other factors were evaluated. Results Ccr and prevalence of GERD （18.52%） in the senile group were higher than those of the non-senile group. There was no difference otherwise between the two groups. There was no significant difference in mean RDQ score between the two groups （4.07±5.27 vs 3.90±6.74）. RDQ score was highly correlated wit dialysate volume per day （r=0.349, P=0.009 ）. Conclusions Senile CAPD patients seemed to have a higher RDQ score and GERD prevalence. Further clinical trials are needed to see whether these differences have any significance. RDQ score is highly correlated with dialysate volume per day.