持续腹膜透析患者的生存率及多变量预后分析

目的分析腹膜透析患者的生存率及其独立的预后因素,观察腹膜转运特性及相关临床特点对患者生存的影响。方法选择北京协和医院肾内科随诊腹膜透析患者232例,采用Cox模型回归分析透析开始时各临床指标对生存时间的影响。结果CAPD患者1年、2年、3年及4年总体生存率分别为91.1%、77.7%、68.7%及55.8%;单因素COX模型回归分析表明：糖尿病患者、腹膜高转运状态、年龄增加、血浆白蛋白低于3.0的患者预期生存率均降低（P〈0.05）。232例患者中180（78%）位患者在开始透析的前6个月完成腹膜平衡实验（PET）,其中高转运状态与死亡显著相关（与低于平均转运患者相比,RR2.70;95% CI 1.03 to 7.05;P=0.043）。经多因素COX模型回归分析,糖尿病和年龄是尿毒症腹膜透析患者死亡的独立危险因素。糖尿病患者死亡的相对危险度为非糖尿病患者的2.96倍（95% CI 1.62 to 5.38;P〈0.0001）;年龄每增加10岁,相对危险度增加0.31（P=0.039）。结论根据透析前年龄、原发病、血清白蛋白和腹膜的转运状态可以对腹膜透析患者的预后进行初步判断。

Survival rate and multivariate analysis of prognostic factors in continuous ambulatory peritoneal dialysis patients

Objective The aim of this study was to identify risk factors influencing survival and to determine baseline peritoneal transport status in the prediction of subsequent survival in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods This study included all adult patients who commenced peritoneal dialysis in this hospital between Jan. 1, 1996, and Dec. 31, 2007, and had a peritoneal equilibration test （PET） performed within 6 months of peritoneal dialysis commencement. Times to death and death-censored technique failure were examined by Kaplan-Meier analyses and multivariate Cox proportional hazards models. Results The overall survival probability after 1 , 2 , 3 and 4 years was 91.1%,77.7%,68.7% and 55.8%, respectively. Patients with diabetes, higher peritoneal transport status, advanced age, serum albumin 〈 30 g/ L, had lower survival probabilities. PET was performed in 180 （78%） of the 232 patients who were treated with peritoneal dialysis in this hospital during the study period. In these patients, higher transport status was found to be a significant predictor of mortality （relative risk 2.70; 95% CI 1.03-7.05; P = 0.043, as compared to those with transport status lower than average）. Cox regression showed that advanced age and diabetes were the independent prognostic predictors. The relative risk （RR） of mortality in diabetic patients was 2.96 times higher than that in non-diabetic patients （95% CI 1.62-5.38; P 〈0.0001）. As age increased by 10 years, the RR increased 0.31 （P=0.039）. Conclusion The prognosis of peritoneal dialysis patients can be preliminarily predicted before the initiation of peritoneal dialysis based on their age, primary diseases, peritoneal transport status and serum albumin.