腹膜透析患者死亡原因分析及血压变异对长期预后的影响

Prognosis of peritoneal dialysis and the effects of blood pressure and variability of blood pressure on mortality

目的 分析腹膜透析患者死亡原因,了解腹膜透析患者血压水平及长时血压变异对预后的影响. 方法 1999年起～2015年1月1日于北京协和医院腹膜透析中心长期随诊腹膜透析患者共482例,收集患者临床及预后资料,分析其死亡的危险因素及死亡原因.选择截止2008年1月31日前存活、开始腹膜透析超过3个月的69例患者.记录其2008年2～12月间连续6次门诊血压,将血压变异系数（CV）作为门诊血压变异指标,随访72个月,记录患者预后资料,分析血压及血压变异对预后的影响.结果 16年间,224例患者死亡,糖尿病（HR2.245,95％ CI1.718～2.932,P＜0.001）及年龄（HR2.840,95％ CI2.065～3.906,P＜0.001）是患者死亡的危险因素.心脑血管疾病（52.2％）及严重感染（25％）分别是前两位死亡原因.69例患者门诊收缩压变异（SBPCV）均值为9.8％±4.7％.随访72个月有33例患者死亡,门诊SBP均值≥153mmHg（1mmHg=0.133kpa）是腹膜透析患者全因死亡（HR2.848,95％ CI1.156～7.015,P=0.023）及心脑血管死亡（HR3.122,95％ CI 1.012～9.635,P=0.048）的独立危险因素.没有观察到门诊血压变异增加腹膜透析患者死亡风险. 结论 高血压是腹膜透析患者全因死亡及心脑血管死亡的独立危险因素,门诊血压变异不增加患者死亡风险.

Objective To analyze the prognosis of peritoneal dialysis（PD） patients and to investigate the association between blood pressure（BP）,the variability of BP and mortality.Methods We included 482 PD patients who had regular visits in our PD center from 1999 to Jan.1,2015 for survival analysis and to identify the risk factors for mortality.Sixty-nine of the PD patients who had been on PD for more than 3 months before Jan.31,2008 were involved in the analysis of the relationship between BP variability and mortality.Consecutive 6 office BP measurements once a month during 2008 were collected from every patient,and the coefficient of variation（CV） for BP was used as an indicator of BP variability.Baseline clinical data and laboratory tests were also reviewed.Patients were followed up for 72 months.All-cause mortality and cardiovascular mortality were analyzed by Cox regression.Results Two hundred and twenty-four PD patients died in the follow-up period for 16 years.Diabetes（HR 2.245,95% CI 1.718～2.932,P〈0.001） and advanced age（HR 2.840,95% CI 2.065～3.906,P〈0.001）were the risk factors for mortality.Cardiovascular event（52.2%）and infection（25%） were the two major causes of death.The CV for systolic blood pressure was 9.8±4.7%.Among the 69 PD patients,33 patients died.Systolic BP ≥153mm Hg was an independent predictor for allcause mortality（HR 2.848,95% CI 1.156～7.015,P=0.023） and cardiovascular mortality（HR 3.122,95% CI1.012～.635,P=0.048）.BP variability was not a predictor for mortality in PD patients.Conclusion Hypertension was an independent predictor for all-cause and cardiovascular mortality for PD patients,but BP variability could not be proved to be a factor affecting the prognosis of PD patients.