合并2型糖尿病腹膜透析患者的转归及影响因素的单中心回顾性分析

The outcome and its influencing factors of peritoneal dialysis patients with type 2 diabetes mellitus

目的探讨合并2型糖尿病患者的开展腹膜透析的结局和危险因素。方法选取2015年5月至2020年5月间在上海中医药大学附属龙华医院肾内科开展腹膜透析时已确诊2型糖尿病的患者,收集病例资料和结局信息,分析筛选出现终点事件即退出腹膜透析的危险因素。结果最终共筛选纳入研究对象113例,其中男性70例(61.95%),女性43例(38.05%),中位年龄60(54,68)岁,中位透析随访时长27(15,48)月。共47例(41.59%)发生了定义的终点事件,其中死亡17例(15.04%),转血液透析30例(26.55%)。经单因素筛选和多因素COX分析显示,肥胖(HR=2.131,95%CI:1.123~4.045,P=0.021)是影响PD病人生存的独立危险因素。113例患者中位腹膜透析时间为50(25,123)月;肥胖患者中位透析时间42(20,71)月,相较于非肥胖病例的中位透析时间85(34,123)月显著减少(X^(2)=5.750,P=0.016);晚透析患者中位透析时间73(33,120)月,相较于非晚透析患者中位透析时间41(20,58)月,差异有统计学意义(X^(2)=4.501,P=0.034)。结论肥胖的合并2型糖尿病患者开展腹膜透析的退出风险相对较高。

Objective To evaluate the outcome and its influence factors of peritoneal dialysis(PD)patients complicated with type 2 diabetes mellitus.Methods The PD patients diagnosed with type 2 diabetes at the beginning of PD and treated in our center from May 1,2015 to May 1,2020 were enrolled in this study.Their clinical data and outcome information were collected.The end-point events were analyzed and the influence factors for the withdrawal of PD were then identified.Results A total of 113 eligible subjects were recruited,including 70 males(61.95%)and 43 females(38.05%)with an average age of 60(54,68)years old and an average PD period of 27(15,48)months.Defined end events that led to the withdrawal of PD developed in 47 patients(41.59%),of which 17 cases(15.4%)died and 30 cases(26.55%)transferred to hemodialysis.Univariate and multivariate COX analyses showed that obesity(HR=2.131,95%CI:1.123~4.045,P=0.021)and the time of starting PD(HR=1.863,95%CI:0.872~3.243,P=0.055)were the independent risk factors for survival of the PD patients.In the survival analysis,the median PD duration was 50(25,123)months in the 113 patients;the median PD duration was 42(20,71)months in obese patients,significantly shorter than that of 85(34,123)months in non-obese patients(X^(2)=5.750,P=0.016).The median PD duration was 73(33,120)months in late dialysis patients,significantly longer than that of 41(20,58)months in nonlate dialysis patients(X^(2)=4.501,P=0.034).Conclusion Obese PD patients with type 2 diabetes have a relatively high risk of withdrawal from PD.