首年门诊随访频率和维持性腹膜透析患者预后的相关性研究

The correlation between first-year outpatient follow-up frequency and outcome of patients with continuous ambulatory peritoneal dialysis

目的探究首年门诊随访频率与持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者预后的相关性。方法纳入2014年1月1日至2015年5月31日期间于武汉市第一医院行腹膜透析置管术的CAPD患者。根据患者首年门诊随访频率的分布特征,将患者分为低频组(>5月/次)、中频组(3.3~5月/次)、高频组(<3.3月/次),比较各组之间的人口学资料、基线生化指标、生存结局、技术生存结局以及腹膜炎发生情况。结果(1)高频组患者的医保比例、教育水平、体质量指数、每周尿素氮清除率(总Kt/V)、血红蛋白(Hb)、白蛋白(Alb)和收缩压优于中、低频组(P<0.05)。(2)生存分析表明接受高频率随访患者的生存率和技术生存率均优于低频组,但差异不具有统计学意义。采用比例风险回归模型和竞争风险模型分析发现,随访频率与生存率及技术生存率无明显相关。(3)单因素Cox回归显示随访频率(OR=0.151,P<0.05)、Alb(OR=0.860,P<0.05)、尿酸(OR=0.996,P<0.05)都与腹膜炎的发生存在相关性,多因素回归显示随访频率对腹膜炎发生率影响有统计学意义(OR=0.216,P<0.05)。受试者工作特征曲线示随访间期为3.58月/次时,预测腹膜炎发生的灵敏度为86.1%,特异度为54.8%。结论经济及教育水平较高、一般情况较好的患者更倾向于高频随访。首年门诊高频随访(随访间期<3.3月/次)是腹膜炎发生的独立保护因素。进入腹膜透析第一年进行低频随访尤其是随访间期长于3.58月/次的患者腹膜炎发生风险大,远期临床结局较差,医护人员可以针对此类患者加强宣教,督促患者后期积极进行门诊随访。

Objective To investigate the correlation of clinical follow-up frequency with prognosis of patients with continuous ambulatory peritoneal dialysis(CAPD).Methods The subjects of this study were patients who carried out peritoneal dialysis catheterization at the First Hospital of Wuhan during January 1,2014~May 31,2015.Based on the distribution characteristics of first-year outpatient follow-up frequency,the patients were divided into low frequency group(>5 months/time),intermediate frequency group(3.3~5 months/time),and high frequency group(<3.3 months/time).Demographic data,baseline biochemical indicators,clinical outcomes,technical survival outcomes,and peritonitis occurrence were compared between groups.Results(1)The proportion of medical insurance,educational level,body mass index,weekly urea nitrogen clearance rate(total Kt/V),hemoglobin(Hb),albumin(Alb)and systolic blood pressure(SBP)in the high frequency group were better than those in the middle and low frequency groups(P<0.05).(2)The Kaplan-Meier curves showed that the survival and technical survival of patients receiving high frequency follow-up were higher than those receiving low frequency follow-up,with the differences of no statistical significance.By proportional risk regression model(Cox regression model)and competitive risk model(competitive risk model),it was found that there was no significant correlation between follow-up frequency and survival and technical survival.(3)Univariate Cox regression showed that follow-up frequency(OR=0.151,P<0.05),albumin(OR=0.860,P<0.05),and uric acid(OR=0.996,P<0.05)were associated with the occurrence of peritonitis.Multivariate regression analysis showed that follow-up frequency had statistically significant effect on peritonitis occurrence(OR=0.216,P<0.05).The subject work characteristic curve(ROC)showed that the sensitivity and specificity of peritonitis occurrence were 86.1%and 54.8%respectively when the follow-up interval was 3.58 months/time.Conclusions The patients with good economy,high education level and good general conditions are prone to have high follow-up frequency.First year high-frequency follow-up(interval<3.3 months/time)is an independent protective factor for peritonitis.The patients who carry out high frequency follow-up during the first year of peritoneal dialysis,especially those with a follow-up interval longer than 3.58 months/time,are at greater risk of peritonitis which may lead to poor long-term clinical outcomes.Therefore,healthcare professionals should be strengthen education for some particular patients,and urge them to conduct follow-up actively in the later stage.