高密度脂蛋白对腹膜透析患者临床转归的影响

Association between high density lipoprotein and clinical outcomes in peritoneal dialysis patients

目的了解持续性不卧床腹膜透析(CAPD)患者血脂异常及临床转归情况,探讨高密度脂蛋白(HDL)对PD患者临床转归的影响。方法回顾性分析2010年1月至2020年1月在广西医科大学第一附属医院规律随访的CAPD患者的临床资料。根据临床转归分为维持组和退出组,比较两组临床资料的差异,探究不同HDL水平与患者临床转归的相关性。结果433例患者中维持组276例,退出组157例(死亡70例、转血液透析87例)。229例合并血脂异常(52.9%),随访中位时间为35.33(21.78,61.17)个月。退出组的糖尿病比例、收缩压高于维持组,而中位透析龄、白蛋白、胆固醇(TC)、HDL低于维持组。血脂异常组PD退出率高于血脂正常组。根据基线HDL三分位水平分为Q1(>2.17 mmol/L)、Q2(1.04~2.17 mmol/L)、Q3(<1.04 mmol/L),HDL-Q3组的PD退出率和全因死亡率均高于HDL-Q1和HDL-Q2组。Cox回归分析提示:校正混杂因素后,HDL下降仍是影响PD患者退出的独立危险因素(P均<0.05)。结论HDL水平是影响PD患者临床转归的重要因素。

Objective To investigate the association between high density lipoprotein(HDL)and clinical outcomes of continuous ambulatory peritoneal dialysis(CAPD)patients.Methods The clinical data of patients received continuous ambulatory peritoneal dialysis were followed up in the First Affiliated Hospital of Guangxi Medical University from January 2010 to January 2020.Patients were divided into the maintenance and withdrawal groups.Cox regression analysis was used to explore the association between HDL and clinical outcomes.Results A total of 433 patients were enrolled with 276 in the maintenance group and 157 in the withdrawal group,in which70 were died,and 87 were transferred to hemodialysis.There were 229 patients with dyslipidemia(52.9%).The median follow-up was 35.33(21.78,61.17)months.The median age of dialysis,serum albumin,total cholesterol(TC)and HDL in withdrawal group were lower than those in maintenance group.According to HDL level,patients were divided into Q1(>2.17 mmol/L),Q2(1.04~2.17 mmol/L)and Q3(<1.04 mmol/L)groups.The PD dropout rate and all-cause mortality in HDL-Q3 group were significantly higher than those in HDL-Q1 and HDL-Q2 groups.Decreased HDL level was an independent risk factor for patients to drop out of PD(all P<0.05).Conclusions Low HDL was an important risk factor affecting all-cause mortality and withdrawal in PD patients.