腹膜透析患者的预后分析

Analysis of Prognostic Risk Factors in Continuous Ambulatory Peritoneal Dialysis Patients

目的探讨腹膜透析患者的生存率及影响预后的危险因素。方法选择2004年1月～2011年8月在常州市第一人民医院行腹膜透析的患者208例，采用Kaplan—Meier生存曲线描述患者的生存率状况，并采用单因素及多因素COX回归分析判断透析开始前各临床指标对生存时间的影响。结果腹膜透析患者1年、2年、3年、4年及5年的总体生存率分别为89．O％、57．2％、39．9％、29．7％及18．7％。单因素COX回归分析表明透析前年龄、糖尿病、冠心病、充血性心衰、脑血管疾病、血清载脂蛋白B-100、脂蛋白（a）（P〈0．1）是影响患者生存的可能因素，多因素COX分析最终显示透析前年龄、糖尿病、血清载脂蛋白B-100、脂蛋白（a）（P〈0．05）是影响腹膜透析患者预后的独立危险因素。结论透析前年龄、糖尿病、血脂代谢紊乱对腹膜透析患者的预后有重要影响。

Objective To investigate the survival rate and prognostic risk factors in continuous ambulatory peritoneal dialysis（CAPD）patients. Methods A total of 208 patients who received CAPD from January 2004 to August 2011 at the Department of Nephrology in the Third Affiliated Hospital of Soochow University were enrolled in the study. Kaplan - Meier analysis was used to plot the survival of CAPD patients.An initial univariate Cox regression analysis was performed to compare all the potential risk factors with mortality. Then the significant variables （ P 〈 0.1 ） on univariate analysis were entered into multivariate Cox regression analysis. Results The overall survival rate of 1,2,3,4 and 5 years was 89% ,57.2% ,39.9% ,29.7%and 18.7% ,respectively.Univariate Cox regression analysis indicated that survival was influenced by age, diabetes mellitus, coronary vascular disease, congestive heart failure, cerebrovascular disease, serum ApaB - 100, and Lp（a）（ P 〈 0.1）. Multivariate Cox regression analysis indicated that survival was influenced by age, diabetes mellitus, serum ApoB - 100, and Lp（a） （ P 〈 0.05）. Conclusion Age, diabetes mellitus,and dyslipidemia are the independent risk factors of the prognosis in CAPD patients.