终末期肾脏病患者腹膜透析治疗时机与其生存率关系的初步探讨

目的 探讨终末期肾脏病腹膜透析治疗时机与患者生存率的关系.方法 选取上海交通大学附属上海第一人民医院肾内科自2004年1月1日～2011年12月31日间,以腹膜透析作为肾脏替代治疗方式的终末期肾脏病患者.通过MDRD公式估计患者透析起始eGFR值,并根据eGFR值将纳入实验的患者分为早透析组[eGFR＞6.5 ml/（min·1.73 m^2）]和晚透析组[eGFR＞6.5 ml/（min· 1.73 m^2）],分析2组患者透析起始时基线数据的差异,以及2组间生存率的关系. 结果 资料完整的177例患者平均年龄（59.02±13.21）岁,平均随访（46±24.77）月,透析起始eGFR中位数水平是6.5 ml/（min· 1.73 m^2）,68.22％患者于5～7.5 ml/（min·1.73 m^2）时才开始透析治疗.早透析组患者85例,透析起始时eGFR值（8.77±3.44） ml/（min·1.73 m^2）;晚透析组患者92例,透析起始时eGFR值（5.54±1.35）ml/min· （1.73 m^2）.对包括性别（χ^2=12.400,P=0.120）、年龄（t=-0.580,P=0.060）、BMI（t=0.450,P=0.55）、血红蛋白（t=0.740,P=0.590）、血白蛋白（t=-1.700,P=0.180）等基本资料统计分析发现,2组透析治疗起始时血肌酐（t=-10.270,P＜0.01）、BUN（t=-2.910,P＜0.01）、eGFR（t=10.050,P＜0.01）、糖尿病肾病（χ^2=7.540,P＜0.05）及并发糖尿病的比例（χ^2=2.600,P＜0.01）有统计学差异,余基线数据均未见明显差异.运用Ka-plan-Meier生存分析比较早、晚透析组患者的生存率,发现2组间的差异仍无统计学意义（χ^2=0.360,P=0.191）.结论 糖尿病肾病患者较其他患者更易接受早期透析治疗,然而终末期肾脏病患者腹膜透析治疗时机与患者生存率之间无明显相关关系.

The association between the timing of peritoneal dialysis and the survival of end stage renal disease patients

Objective To explore the relationship between the timing of peritoneal dialysis （PD） and the survival of end stage renal disease patients.Methods We studied the patients diagnosed as uremia and treated with PD in our hospital from January 1st,2004 to 31st December,2011.They were divided into early group and late group based on estimated glomerular filtration rate calculated by MDRD formulation.We then analyzed the differences in demographic and laboratory data and compared the survival rate between the two groups.Results This study consisted of 177 patients with the median eGFR of 6.5 ml/min·（1.73 m^2）.Eightfive patients were in the early group with a mean eGFR of 8.77±3.44 ml/min· （1.73 m^2）,and 92 patients in the late group with a mean eGFR of 5.54±1.35 ml/min·（1.73 m^2）.Differences between the two groups were found in serum creatinine （t=-10.270,P〈0.01）,BUN （t=2.910,P〈0.01）,eGFR （t=10.050,P〈0.01）,diabetic nephropathy （χ^2=7.540,P〈0.05）,and diabetes comorbidity （χ^2=2.600,P〈0.01）.Kaplan-Meier analysis showed no significant difference in survival rate between the two groups （χ^2=0.360,P=0.191）.Conclusion There was no relationship between the timing of PD and the survival of end stage renal disease patients.