营养不良、炎症和动脉粥样硬化与腹膜透析患者预后关系的研究

Correlation of malnutrition, inflammation, and atherosclerosis and prognosis of patients undergoing peritoneal dialysis

目的分析合并有营养不良、炎症及心血管疾病的腹膜透析（腹透）患者的长期预后,及上述合并症对腹透患者全因死亡及心血管死亡的影响。方法入选2005年1月1日至2009年12月31日期间在上海交通大学医学院附属仁济医院腹透中心开始透析的终末期肾脏病（ESRD）患者。采用Kaplan-Meier法分析患者生存率、技术生存率以及无腹膜炎生存时间。采用Cox比例风险模型分析患者全因死亡和心血管死亡的危险因素。结果共有256例患者入选本研究,其中同时合并营养不良、炎症以及心血管疾病的患者有20例（7.8%）。3种合并症组患者的1年、2年、3年和5年生存率明显低于无合并症患者（χ^2=16.200,P〈0.001）,而技术生存率和无腹膜炎生存时间与无合并症患者相比差异无统计学意义（P〉0.05）。任意2种合并症（HR=3.624,95%CI为1.376~9.543,P=0.009）或3种合并症（HR=5.012,95%CI为1.629~15.419,P=0.005）是影响患者全因死亡的独立危险因素;任意2种合并症（HR=10.324,95%CI为1.332~80.032,P=0.025）、3种合并症（HR=11.821,95%CI为1.342~104.097,P=0.026）是影响患者心血管死亡的独立危险因素。结论营养不良、炎症及心血管疾病任意2种及3种合并症的存在是影响腹透患者生存的独立危险因素,与心血管死亡的密切相关。

Objective To analyze the long-term prognosis of patients with malnutrition-inflammation-atherosclerosis（ MIA） syndrome who undergo the peritoneal dialysis（ PD） and the effects of MIA syndrome on the all-cause mortality and cardiovascular disease（ CVD） mortality. Methods Patients with end-stage renal disease（ ESRD）who underwent PD between January 1, 2005 and December 31, 2009 in the Center for Peritoneal Dialysis Research of Renji Hospital, Shanghai Jiao Tong University School of Medicine were selected. The survival rate, technical survival rate, and survival time of patients without peritonitis were analyzed by the Kaplan-Meier method. Risk factors of all-cause mortality and CVD mortality were analyzed by the Cox proportional hazards models. Results A total of 256 patients were selected. There were 20（ 7. 8 %） patients with MIA syndrome. The 1-year, 2-year, 3-year, and 5-year survival rates of patients with MIA syndrome were significantly lower than those of patients without MIA syndrome（ χ^2= 16. 200, P〈0. 001）. The differences of technical survival rate and survival time of patients without peritonitis of patients with and without MIA syndrome were not statistically significant（ P〉0. 05）. Two complications（ HR = 3. 624; 95 % CI： 1. 376- 9. 543; P = 0. 009） or 3complications（ HR = 5. 012, 95 % CI： 1. 629- 15. 419, P = 0. 005） were independent risk factors that influenced the all-cause mortality. Two complications（ HR = 10. 324; 95 % CI： 1. 332- 80. 032; P = 0. 025）or 3 complications（ HR = 11. 821; 95 % CI： 1. 342- 104. 097; P = 0. 026） were independent risk factors that influenced the CVD mortality. Conclusion Any two of or all of malnutrition, inflammation, and atherosclerosis are independent risk factors that influence the survival of patients undergoing the peritoneal dialysis and closely relevant to the CVD mortality.