腹腔压力与早期腹膜透析渗漏的相关性研究

Study on the relationship between peritoneal pressure and early leakage of peritoneal dialysis

目的探讨腹膜透析(peritoneal dialysis,PD)患者腹腔压力(intraperitoneal pressure,IPP)与早期PD渗漏发生的相关性。方法前瞻性选择并记录2020年10月~2021年9月在哈尔滨医科大学附属第二医院肾内科首次行早期PD的60例患者的临床资料,依据2000ml进液量时的IPP值及是否发生渗漏进行分组,比较各组的临床指标差异,并行相关性分析。结果①不同腹压组间体质量(F=6.205,P=0.001)、体质量指数(body mass index,BMI)(F=16.008,P<0.001)、腹围(F=9.561,P<0.001)、体表面积(body surface area,BSA)(F=4.048,P=0.011)、血肌酐(K=8.266,P=0.041)、血嗜酸性粒细胞值(K=9.855,P=0.020)、渗漏发生(χ^(2)=17.304,P=0.001)比较差异有统计学意义。渗漏组腹腔内容量(intraperitoneal volume,IPV)分别为500ml(Z=-2.599,P=0.009)、1000ml(t=4.216,P<0.001)、2000ml(Z=-3.025,P=0.002)的腹压值及女性所占比例(χ^(2)=5.875,P=0.015)高于非渗漏组,血嗜酸性粒细胞值(Z=-2.377,P=0.017)在渗漏组较低。②Spearman秩相关分析显示IPP与体质量(r=0.479,P<0.001)、BMI(r=0.665,P<0.001)、BSA(r=0.383,P=0.002)、腹围(r=0.569,P<0.001)、IPV(r=0.537,P<0.001)、IPV/BMI(r=0.354,P<0.001)、IPV/BSA(r=0.436,P<0.001)、渗漏(r=0.370,P=0.004)呈正相关,与血嗜酸性粒细胞(r=-0.304,P=0.018)呈负相关;与血肌酐无相关性(r=0.082,P=0.539)。渗漏发生与IPV分别为500ml(r=0.338,P=0.008)、1000ml(r=0.394,P=0.002)、2000ml(r=0.394,P=0.002)的腹压值呈正相关,与嗜酸性粒细胞呈负相关(r=-0.309,P=0.016)。③Logistic回归分析显示:体质量(OR=2.570,95%CI:1.448~4.561,P=0.001)、BMI(OR=2.115,95%CI:1.415~3.159,P<0.001)、腹围(OR=1.205,95%CI:1.073~1.353,P=0.002)、BSA(OR=1.046,95%CI:1.010~1.083,P=0.012)是IPP的独立危险因素;性别(OR=9.739,95%CI:1.134~83.674,P=0.038)及IPV分别为500ml(OR=1.535,95%CI:1.120~2.104,P=0.008)、1000ml(OR=1.606,95%CI:1.173~2.198,P=0.003)、2000ml(OR=1.564,95%CI:1.164~2.102,P=0.003)的腹压值是渗漏发生的独立危险因素。结论体质量、BMI、腹围、BSA可作为预估早期PD患者IPP的临床指标。本研究中女性比男性更容易出现早期渗漏,IPP与早期渗漏发生有密切联系,IPP增高在一定程度上促进早期渗漏的发生。

Objectives To investigate the relationship between intraperitoneal pressure(IPP)and early leakage of peritoneal dialysis(PD)in PD patients.Methods A total of 60 patients undergoing PD catheterization for first time during October 2020 to September 2021 at the Department of Nephrology,The Second Affiliated Hospital of Harbin Medical University were prospectively analyzed.Their clinical data were collected and then divided into groups according to the IPP after infusion of 2,000ml dialysate and the presence or absence of leakage.Clinical indicators were compared among the groups and correlation analysis was performed.Results①Body weight(F=6.205,P=0.001),body mass index(BMI)(F=16.008,P<0.001),abdominal circumference(F=9.561,P<0.001),body surface area(BSA)(F=4.048,P=0.011),serum creatinine(K=8.266,P=0.041),blood eosinophil number(K=9.855,P=0.020)and leakage(χ^(2)=17.304,P=0.001)were significantly different among the groups with different IPP(P<0.05).The IPP values at the intraperitoneal dialysate volume(IPV)of 500ml,1,000ml and 2,000ml were higher in the leakage group than in the non-leakage group(Z=-2.599,4.216 and-3.025 respectively;P=0.009,<0.001 and=0.002 respectively).The ratio of females was higher in the leakage group than in the non-leakage group(χ^(2)=5.875,P=0.015);blood eosinophil number was lower in the leakage group(Z=-2.377,P=0.017).②Spearman rank correlation analysis showed that IPP was positively correlated with body weight(r=0.479,P<0.001),BMI(r=0.665,P<0.001),BSA(r=0.383,P=0.002),abdominal circumference(r=0.569,P<0.001),IPV(r=0.537,P<0.001),IPV/BMI(r=0.354,P<0.001),IPV/BSA(r=0.436,P<0.001)and leakage(r=0.370,P=0.004),negatively correlated with blood eosinophil number(r=-0.304,P=0.018),and had no correlation with serum creatinine(r=0.082,P=0.539).The presence of leakage was positively correlated with the IPP values at the IPV of 500ml(r=0.338,P=0.008),1000mL(r=0.394,P=0.002)and 2000ml(r=0.394,P=0.002),and negatively correlated with blood eosinophil number(r=-0.309,P=0.016).③Logistic regression analysis showed that body weight(OR=2.570,95%CI:1.448~4.561,P=0.001),BMI(OR=2.115,95%CI:1.415~3.159,P<0.001),abdominal circumference(OR=1.205,95%CI:1.073~1.353,P=0.002)and BSA(OR=1.046,95%CI:1.010~1.083,P=0.012)were the independent risk factors for IPP;gender(OR=9.739,95%CI:1.134~83.674,P=0.038)and IPP values at the IPV of 500ml(OR=1.535,95%CI:1.120~2.104,P=0.008),1000ml(OR=1.606,95%CI:1.173~2.198,P=0.003)and 2000ml(OR=1.564,95%CI:1.164~2.102,P=0.003)were the independent risk factors for leakage.Conclusions Body mass,BMI,abdominal circumference and BSA can be used as the clinical indicators to predict IPP in patients with PD at early stage.In these PD patients,women are more prone to have early leakage than men.IPP is closely related to the early leakage,and the increase of IPP is one of the important factors leading to early leakage.