腹膜透析患者容量负荷的相关影响因素研究

Study on the relevant factors affecting the hydration status in peritoneal dialysis patients

目的·探讨维持性腹膜透析患者容量负荷的相关影响因素。方法·选取2016年9月至2017年1月上海交通大学医学院附属仁济医院的规律腹膜透析患者,采集患者的人口学资料,检测生化指标,评估患者的腹膜转运特性及透析充分性,应用多频生物电阻抗技术测量患者容量超负荷指标overhydration(OH)值。采用多元线性回归分析OH值的独立相关因素。结果·共入选147例患者,其中男性90例(61.2%),年龄中位数为58.52岁,透析龄中位数为43.03个月,21例(14.3%)患者合并糖尿病,容量超负荷(OH>1.1 L)患者共107例(72.8%)。与正常容量负荷组(OH≤1.1 L)患者相比,容量超负荷组患者的糖尿病比例、体表面积、Charlson合并症评分、血清脑钠肽(BNP)水平、腹膜平衡试验结果 (4 h D/Pcr)、24 h透出液蛋白均显著增高(均P<0.05),而总尿素清除率(Kt/V)、血清白蛋白降低(均P<0.05)。多元线性回归分析结果显示:合并糖尿病(P=0.000)、较高的4 h D/Pcr(P=0.000)和较低的血清白蛋白(P=0.001)是OH值升高的独立相关因素。结论·维持性腹膜透析患者普遍处于容量超负荷状态,合并糖尿病、高4 h D/Pcr和低血清白蛋白是容量超负荷的独立相关因素。

Objective · To explore influencing factors associated with the hydration status in peritoneal dialysis （PD） patients. Methods · Eligible PD patients treated in Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September 2016 to January 2017 were enrolled. Demographic data of patients were collected and biochemical indexes were measured. Their peritoneal transport characteristics and dialysis adequacy were evaluated. Hydration status index overhydration （OH） value was measured with bioimpedance spectroscopy. Multivariate linear regression was used to analyze the independent factors associated with the OH. Results · A total of 147 PD patients with a median age of 58.52 years and a median PD duration of 43.03 months were enrolled. Of them, 90 （61.2%） were male, 21（14.3%） were accompanied by diabetes mellitus, and 107 （72.8%） were overhydrated （OH〉1.1L）. Compared to those with normal hydration status （OH ≤？1.1 L）, the overhydrated patients had higher proportion of diabetes, BSA, Charlson comorbidity score, brain natriuretic peptide （BNP）, 4 h D/Pcr, and 24 h dialysate protein, and lower tKt/V, serum albumin than the normal hydrated patients （all P〈0.05）. Multivariate linear regression showed that comorbid diabetes mellitus （P=0.000）, higher 4h D/Pcr （P=0.000）, and lower serum albumin level （P=0.001） were independent relevant factors for the increase of OH. Conclusion · Overhydration is common in PD patients. Comorbid diabetes mellitus, higher 4 h D/Pcr, and lower serum albumin are independent relevant factors for the hydration status in PD patients.