持续非卧床腹膜透析患者结局预测因素分析

目的了解持续非卧床腹膜透析（continuous ambulatory peritoneal dialysis, CAPD）患者累积生存率,分析CAPD患者结局的预测因素。方法采用前瞻性观察研究方法,连续纳入符合观察条件的CAPD患者148例,调查生活方式并检测腹膜透析前基线肾功能和血清生化指标,采用Kaplan-Meier法分析生存率,Cox比例风险回归模型分析结局影响因素。结果中位随访时间78个月,CAPD患者3年和5年生存率分别为71.2%和53.7%,心脑血管死因占53.2%,血清钙磷乘积是心脑血管死因的独立影响因素;中三分位血清钙磷乘积比高三分位血清钙磷乘积死亡风险减少76.2%（OR=0.238,95%CI 0.070~0.814,P=0.022）。多因素Cox比例模型分析显示,高龄、低血清白蛋白（albumin,Alb）和总淋巴细胞计数（total lymphocyte count, TLC）是CAPD患者全因死亡风险的预测因子。与<60岁的患者比较,年龄60~75岁和＞75岁患者死亡风险显著增加（HR=2.176,95%CI 1.213~3.902,P=0.009;HR=3.584,95%CI 1.914~6.636,P<0.001）;与血清Alb＞30g/L的患者比较,血清Alb 25~30g/L和Alb＜25g/L的患者死亡风险增加（HR=1.753,95%CI 1.009~3.046,P=0.047;HR=2.075,95%CI 1.125~3.829,P=0.020）;与低三分位TLC比较,中三分位TLC的患者死亡风险减少50.8%（HR=0.492,95%CI 0.276~0.876,P=0.016）。结论心脑血管事件是CAPD患者的主要死亡原因,基线高龄、低血清Alb和TLC是CAPD患者全因死亡风险的预测因子。     

单中心初始血液透析患者透前贫血治疗状况的回顾性调查

目的：了解2011年单中心初始血液透析患者透前贫血情况,并进行相关影响因素分析。方法：按标准纳入广州市第一人民医院2011年1月1日~2011年12月31日新增的初始血液透析患者92例。收集人口学资料、肾病病史、就诊史、原发病、合并症及实验室检查指标。使用多元线性回归分析血红蛋白与性别、年龄、缴费类别、肾病病史、就诊史、糖尿病、感染、红细胞生成刺激剂（ erythropoiesis-stimulating agents,ESA）使用史、估计肾小球滤过率（ estimated glomerular filtration rate,eGFR）、二氧化碳结合力（ECO2）、血清白蛋白（Alb）。结果：92例患者平均年龄（57.8±16.9）岁,平均Hb（72.7±14.6）g/L;与Hb〈90 g/L组相比,Hb≥90 g/L组有更多的肾内科就诊史和有ESA使用史,差异有统计学意义;多元线性回归分析显示,影响Hb的危险因素包括合并感染、有ESA使用史、eGFR和Alb。结论：本中心初次血液透析患者进入透析时贫血严重,贫血严重程度与合并感染、有ESA使用史、eGFR和Alb水平相关。     

Correlation analysis of N-terminal pro-brain natriuretic peptide in maintenance hemodialysis patients

Objective To analysis the distribution and influence factors of N-terminal pro-brain natriuretic peptide (NT-pro BNP), and also its clinical significance though a cross-sectional survey of NT-pro BNP in maintenance hemodialysis patients in Zhongshan Hospital, Fudan University. Methods A total of 207 stable hemodialysis patients were enrolled. The clinical parameters, plasma NT-proBNP levels and echocardiographic parameters were analyzed. Results Level of plasma NT-proBNP in patients with left ventricular hypertrophy (LVH) were significantly higher than those without LVH[M(1/4, 3/4): 3 104(1 626, 7 843) ng/L vs 1 291(772, 1 845) ng/L, P﹤0.01]. After logarithmic transformation for skewed variables NT-proBNP, log[NT-proBNP] was negatively correlated with hemoglobin (r=-0.212, P=0.004) and left ventricular ejection fraction (LVEF)(r=-0.202, P=0.003), and was positively correlated with left ventricular mass index (LVMI)(r=0.370, P=0.001), interdialysic weight gain (IDWG) rate (r=0.233, P=0.001), predialysis systolic blood pressure (r=0.345, P=0.001), predialysis diastolic blood pressure (r=0.152, P=0.032). The areas under curve(AUC) of NT-proBNP for diagnosing LVH and IDWG﹥4% were 0.786(95%CI 0.689-0.883, P﹤0.01) and 0.738(95%CI 0.667-0.810, P﹤0.01). When the threshold of NT-proBNP was set at 1 917 ng/L to diagnosis LVH, the sensitivity and specificity were 0.676 and 0.824. When the threshold of NT-proBNP was set at 2 872 ng/L to diagnosis IDWG﹥4%, the sensitivity and specificity were 0.704 and 0.758. Conclusions NT-proBNP levels are significantly abnormality in hemodialysis patients, mainly related with LVH, the high rate of IDWG, and the poorly controlled predialysis blood pressure. Proper dry weight assessment and strict control of IDWG may be effective way to intervene NT-proBNP.     

Association between nutrition and peripheral artery disease in continuous ambulatory peritoneal dialysis patients

Objective To investigate the association between nutrition and peripheral artery disease (PAD) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods One hundred and two stable CAPD patients from a single center were enrolled in this cross-sectional study. Automatic ankle-brachial index (ABI) measuring system was applied to examine ABI. Patients were divided into PAD group (ABI＜0.9) and non-PAD group (ABI≥0.9). Clinical data were collected. Biochemical parameters were detected. Nutritional status was evaluated by serum albumin, handgrip strength (HGS) and subjective global assessment (SGA). Logistic regression analysis was performed to estimate the association of PAD with each nutritional marker as well as other potential risk factors. Results The incidence of PAD was 23.53% (24/102). ABI was significantly lower in patients with malnutrition as compared to those without malnutrition [(0.72±0.21) vs (1.04±0.14), P＜0.01]. Compared with non-PAD patients, serum albumin (P＜0.01), HGS (P＜0.01), diastolic blood pressure (P＜0.05), serum creatine (P＜0.05)、blood urine nitrogen (P＜0.01) were significantly decreased, but age (P＜0.01), the incidence of malnutrition [SGA, P＜0.01], diabetic status (P＜0.01), cardiovascular disease history (P＜0.01) were significantly increased in PAD patients. Logistic regression analysis showed that serum albumin (OR=0.762, 95％CI：0.611-0.948, P=0.015), HGS (OR=0.988, 95％CI：0.979-0.997, P=0.013) were independent protective factors for PAD, malnutrition [(SGA), OR=21.101, 95％CI：5.008-88.901, P＜0.01] was independent risk factor for PAD in CAPD patients. Conclusions The PAD incidence of CAPD patients in our center is 23.53%. Nutrition is independent factor associated with PAD in CAPD patients.     

血脂代谢紊乱与腹膜透析置管大网膜包裹的关系

目的探讨血脂代谢紊乱和腹膜透析置管术后发生大网膜包裹的关系。方法选择中南大学湘雅医院肾内科收集腹膜透析置管术后发生大网膜包裹病例15例,以同期未发生大网膜包裹病例30例为对照,对比二组发生血脂代谢紊乱的差异。同时,以是否存在血脂代谢紊乱分组,对比腹膜透析置管术后大网膜包裹的发生率。结果大网膜包裹组的三酰甘油（TG）、胆固醇（CHO）和低密度脂蛋白（LDL）明显高于非大网膜包裹组;大网膜包裹组载脂蛋白A1（APOA1）水平则低于非大网膜包裹组。结论血脂代谢紊乱与腹膜透析置管术后发生大网膜包裹相关,可能是易于发生大网膜包裹的一个危险因素。     

肾清汤灌肠联合结肠透析治疗慢性肾功能衰竭临床研究

目的:观察肾清汤灌肠联合结肠透析治疗慢性肾功能衰竭的临床疗效。方法:将慢性肾功能衰竭患者100例,随机分为治疗组和对照组各50例。对照组给予基础治疗(饮食教育、治疗原发病、控制血压、纠正电解质紊乱及代谢性酸中毒、纠正贫血、调节钙磷代谢、防止感染等);治疗组在对照组的基础上加用肾清汤灌肠联合结肠透析,2组均观察治疗10 d,统计2组临床疗效及不良反应情况,检测2组治疗前后肌酐(SCr)、尿素氮(BUN)、内生肌酐清除率(CCr)、血红蛋白(Hb)、血浆白蛋白(Alb)水平变化。结果:治疗组总有效率为86.0%,对照组为64.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组SCr、BUN水平均较治疗前降低(P<0.05),CCr值较治疗前升高(P<0.05);且治疗组各项指标改善较对照组更显著(P<0.05)。治疗后2组患者Alb改善不大,治疗前后及组间比较,差异均无统计学意义(P>0.05)。治疗后,2组患者Hb均较治疗前升高(P<0.05),且治疗组Hb升高较对照组更显著(P<0.05)。治疗组不良反应发生率为26.0%,对照组为18.0%,2组比较,差异无统计学意义(P>0.05)。结论:肾清汤灌肠联合结肠透析治疗慢性肾功能衰竭疗效显著。     

用动力学模型定量分析低钠透析液对钠清除量的影响

目的　定量地分析低钠透析液对钠清除量的影响以便为临床减少钠潴留的发生提供策略。方法　我们依据三孔模型 ,建立了单次透析过程中钠转运的数学模型 ,描述了低钠透析液对钠清除量的影响。并在合理假设的基础上探讨了低钠透析液中合适的钠浓度。结果　钠浓度每降低 5mmol/L ,清除量增加 0 .2 3g。低钠透析液中合适的钠浓度可能 1 2 8mmol/L。结论　低钠透析液能够明显增加钠的清除。     

对居家腹膜透析患者开展健康教育的效果评价

目的 评价肾友会在居家腹膜透析患中开展健康教育的效果。方法 应用健康教育程序，向居家腹膜透析患传授腹膜透析知识及技术。结果 22位居家腹膜透析患，肾友会前，后进行腹膜透析知识书面笔试及换液技术操作考核的平均成绩有显差异（P＜0．05），表明肾友会后患对腹膜透析知识及换流技术的掌握程度有显提高。结论 肾友会是一种对居家腹膜透析患进行相关健康教育的有效形式，具有良好的社会与经济效益。     

影响腹膜透析患者社会回归因素的分析

目的：通过分析影响腹透患者社会回归的因素，探求促进腹透患者社会回归的途径。方法：分析16l例透析时间超过3个月的腹透患者的社会回归现状，分析患者的个人情况、临床治疗情况、社会心理及经济情况，探讨影响社会回归的可能因素。结果：社会回归为1级的患者占总患者数的13％，2级2912％，3级47．8％，4级12.4％。影响社会回归的因素为Charlson并发症指数、Hamilton抑郁积分、Engle系数。结论：加强慢性肾脏病的一体化治疗、改善患者的心理社会及经济因素可能是改善腹透患者社会回归的有效途径。     

腹膜透析患者退出原因分析及防治措施

目的通过分析持续性非卧床腹膜透析（continuousambulatoryperitonealdialysis,CAPD）患者退出腹膜透析者的原因并探讨相应对策。方法收集我院2009年4月至2013年2月因慢性肾衰竭（chronicrenalfailure,CRF）接受CAPD患者的临床资料,分析患者退出的各种原因及所占比例。具体分组如下：①按照退出原因进行分组,比较各组在透析前各项实验室指标、原发病因的差异;②按照腹膜透析患者的文化程度及医疗付费方式等情况进行分组,观察组间退出率有无差异。结果95例患者退出腹膜透析的有32例（退出率33．7％）,退出原因为死亡17例（53．2％）,经济困难放弃治疗5例（15．6％）,转血液透析6例（18．8％）,肾移植4例（12．4％）,死亡原因主要为心脑血管事件和肺部感染;死亡组年龄明显高于其他组,而透析前残余肾功能显著低于对照组;初中及以上文化组（组1）共12例退出（退出率19．4％）,明显低于初中以下文化组（组2）共20例退出（退出率60．6％）,而医保患者的退出率（30．7％）明显低于自费组的退出率（75．8％）。结论死亡是CAPD患者短期内退出腹膜透析的主要原因,心脑血管事件、肺部感染是导致CAPD患者死亡的主要原因,而患者的文化程度及经济因素也是导致腹膜透析患者退出的重要原因,因此在积极加强透析前的系统治疗及透析后的持续合理管理之外,还应向患者反复讲解CAPD的正规操作方法及注意事项。