营养不良对腹膜透析患者生存及心功能的影响

Influence of malnutrition on survival and cardiac function of peritoneal dialysis patients

目的探讨营养不良对持续性非卧床腹膜透析治疗(CAPD)患者预后及心脏结构和功能的影响。方法纳入2013年1月1日至2018年12月31在开平市中心医院开始行CAPD治疗并规律随访的患者130例,回顾分析其临床资料,根据国际肾脏营养与代谢协会制订“蛋白质-能量消耗”(PEW)诊断标准,将入组CAPD患者分为营养不良及非营养不良组,比较两组全因死亡率及心血管死亡率,透析后6个月采用超声心动图检测患者心脏结构及功能的变化。结果两组性别、合并糖尿病比例、清蛋白、总胆固醇、超敏C反应蛋白(hs-CRP)、尿素总清除率(Kt/Vurea)、残余肾小球滤过率(rGFR)比较,差异有统计学意义(P<0.05)。Kaplan-Meier生存曲线显示,营养不良组全因死亡及心血管死亡率均明显高于非营养不良组(P<0.05)。透析治疗6个月后,营养不良组左心室舒张末期内径(LVEDd)增大,射血分数(EF)下降(P<0.05)。结论营养状况与CAPD患者的心脏结构及功能相关,可能影响腹膜透析患者的生存预后。

Objective To study the effects of malnutrition on the prognosis and cardiac structure and function of the patients undergoing continuous ambulatory peritoneal dialysis(CAPD).Methods A total of 130 patients starting the CAPD treatment and undergoing the regular follow up in the Kaiping Municipal Central Hospital from January 1,2013 to December 31,2018 were included.Their clinical data were retrospectively analyzed.According to the"protein-energy consumption"(PEW)diagnostic criteria formulated by the International Association of Renal Nutrition and Metabolism,the enrolled CAPD patients were divided into the malnutrition and non-malnutrition groups.Then the all-cause death rate and cardiovascular death rate were compared between the two groups.The echocardiography was adopted to detect the cardiac structure and function changes after 6-month dialysis.Results There were statistically significant difference in the gender,proportion of complicating diabetes,albumin,total cholesterol,high-sensitivity C-reactive protein(hs-CRP),total urea clearance(Kt/Vurea),residual glomerular filtration rate(rGFR)between the two groups(P<0.05).The Kaplan-Meier survival curve showed that all-cause mortality rate and cardiovascular mortality rate in the malnutrition group were significantly higher than those in the non-malnutrition group(P<0.05).After 6-month dialysis treatment,the left ventricular end-diastolic diameter(LVEDd)in the malnutrition group was increased,while the ejection fraction(EF)was decreased(P<0.05).Conclusion The nutritional status is related to the heart structure and function of the patients with peritoneal dialysis(PD),and may affect the survival prognosis of PD patients.