初始腹膜透析患者透出液癌抗原125水平的影响因素分析

Analysis of associated factors of dialysate cancer antigen 125 in initial peritoneal dialysis patients

目的 探讨初始腹膜透析患者透出液癌抗原125（CA125）水平的影响因素。方法入选2005年1月1日-2009年12月31日在上海交通大学医学院附属仁济医院腹膜透析中心开始规律腹膜透析且所有资料完整的持续非卧床腹膜透析患者。收集人选患者的性别、年龄、身高、体重、原发病、合并症等资料，合并症包括糖尿病、高血压、心血管疾病（CVD）；计算BMI和体表面积（BSA）；开始规律腹膜透析1个月后测定血清白蛋白、高敏C反应蛋白（hs～CRP）、血红蛋白等水平，采用化学发光法测定透出液CA125水平，采用标准腹膜平衡试验评估腹膜转运功能，收集24h的尿液和腹膜透析透出液，计算尿素清除指数（Kt／V）、内生肌酐清除率（Ccr）、残余。肾功能（RRF）、标化蛋白分解率（nPCR）。计算肌酐的腹膜溶质转运面积系数（MTACcr）来评估腹膜溶质转运功能。采用多元线性回归分析影响透出液CA125水平的相关因素。结果共241例患者人选本研究，男112例（46．5％）、女129例（53．5％），平均年龄为（54．9±16．2）岁，合并糖尿病58例（24．2％）、高血压171例（71．0％）、CVD30例（12．4％），中位透出液CAl25水平为11．20（7．20，19．99）U／mL。合并cVD患者的中位透出液CAl25水平显著高于未合并CVD者（P一0．001）。合并与未合并CVD患者的原发病分布的差异有统计学意义（P=0．02），合并CVD患者中原发病为糖尿病肾病的患者构成比高于未合并CVD者。对患者的性别、年龄、合并症、RRF等因素进行校正后，多元回归分析显示，lgMTACcr（B=0．350，95％CI为0．039～0．661，P=0．028）、合并cVD（B=0．196，95oACI为0．076～0．317，P=0．002）与透出液CA125水平独立相关，年龄、lgBSA、腹膜Kt／V、RRF、lg24h超滤量、4h超滤量、性别、合并糖尿病、合并高血压、血清白蛋白水平与透出液CAl25水平不相关（P值均〉0．05）。结论在开始规律腹膜透析1个月后的初始阶段，腹膜透析患者的腹膜MTACcr、合并CVD与其透出液CA125水平独立相关，提示在腹膜透析早期腹膜间皮细胞的数量和转化情况可能与腹膜溶质转运功能有关。

Objective To analyze the associated factors of cancer antigen 125 （CA125） in dialysate in patients undergoing continuous ambulatory peritoneal dialysis （CAPD;）. Methods The patients who started CAPD in Renji Hospital from January 1, 2005 to December 31, 2009 were enrolled in this study. Demographic information such as gender, age, weight, primary diseases and complications which involved diabetes, hypertension, cardiovascular disease （CVD） were collected from those patients with complete medical record. Body mass index （BMI） and body surface area （BSA） were calculated. Clinical biochemical indicators, such as serum albumin, high-sensitivity C-reactive protein （hs-ORP） and hemoglobin were measured one month after regular peritoneal dialysis （PD）, and dialysate CA125 concentrations in the overnight effluent were measured by chemiluminescence. Standard peritoneal equilibration test （PET） was used to assess peritoneal transport function. 24-hour urine and dialysate were collected to calculate urea clearance index （Kt/V）, creatinine clearance rate （Ccr）, residual renal function （RRF）, and normalized protein catabolic rate （nPOR）. Mass transfer area coefficient of creatinine （MTAOcr） was applied to evaluate the peritoneal sotute transport function. Multiple linear regression was used to analyze the independent factors associated with dialysate CA125. Results A total of 241 patients were enrolled in this study. Among them, 112 （46.5%） were male and 129 （53.5%） were female, with a mean age of （54.9±16.2） years. There were 58 patients （24.2%） with diabetes, 171 （71.0%） with hypertension and 30 （ 12.4% ） with CVD. The median dialysate 0A125 concentration was 11.20 （7.20, 19.99） U/mL . Dialysate CA125 level in patients with OVD was significantly higher than those without CVD （ P = 0. 001 ）. Differences were statistically significant in their distribution of primary disease （ P = 0.02）. The primary disease in patients with CVD mainly was diabetic nephropathy. After correction of demographic and clinical parameters, multiple linear regression showed that IgMTAOcr （B=0.350, 95%C1： 0.039-0.661, P=0.028） and OVD （B=0. 196, 95%C1： 0.076-0.317, P = 0. 002） were independently associated with dialysate CA125 level. However, age, IgBSA, peritoneal Kt/V, RRF, Ig 24 hours ultrafiltration function, 4 hours ultrafiltration function, gender, serum albumin, diabetes or hypertension were irrelevant to dialysate CA125 （all P 〉 0. 05）. Conclusion MTACcr and CVD are independently associated with dialysate CA125 level one month after PD, suggesting that peritoneal mesothelial cell mass and turn-over might be associated with peritoneal solute transport function in early period of PD.