腹膜透析患者脉压的影响因素及其与患者病死率的关系

目的 探讨腹膜透析(腹透)患者脉压的影响因素及其与病死率的关系.方法 以腹透超过6个月且年龄在18周岁及以上的患者作为研究对象.收集患者相关临床资料,以腹透开始6个月内的血压平均值计算脉压作为基线值,所有患者随访至死亡、退出腹透、转其他中心、失访或研究终止日期(2010年12月31日).采用多元线性回归分析腹透患者脉压的独立影响因素,以多因素Cox风险比例模型分析脉压及其影响因素与患者病死率的关系.结果 共入选腹透患者498例.多元线性回归分析结果显示:年龄(β=2.34,P＜0.001)、血清白蛋白(β=-0.235,P=0.004)、糖尿病(β=4.93,P＜0.001)是腹透患者脉压的独立影响因素.单因素分析结果显示:脉压与患者的全因死亡(HR=1.017,95％ CI 1.007 ～1.027,P＜0.001)和心血管死亡(HR=1.016,95％CI 1.003～ 1.030,P=0.019)密切相关;进一步的多因素Cox风险比例模型分析结果显示:老龄(HR=1.065,95％ CI1.047～1.082,P＜0.001)、低血清白蛋白(HR =0.945,95％CI 0.909 ～ 0.983,P=0.005)和低血红蛋白(HR =0.981,95％ CI0.971 ～0.991,P＜0.001)是腹透患者全因死亡的独立危险因素;老龄(HR=1.041,95％CI 1.016～1.066,P=0.001)、低血红蛋白( HR =0.983,95％CI 0.969 ～0.996,P=0.014)是腹透患者心血管死亡的独立危险因素;多因素校正后的分析并未显示脉压是腹透患者全因死亡(HR=1.019,95％CI 0.996 ～ 1.043,P=0.104)和心血管死亡(HR=0.988,95％CI 0.860～1.136,P=0.870)的独立危险因素.结论 年龄、血清白蛋白、糖尿病是腹膜透析患者脉压的独立影响因素;脉压与腹透患者病死率的关系尚有待深入研究.

Risk factors of pulse pressure and association of pulse pressure with mortality in patients undergoing peritoneal dialysis

Objective To investigate the risk factors of pulse pressure,and explore the association of pulse pressure with mortality in patients undergoing peritoneal dialysis.Methods Patients aged over 18 and had a history of peritoneal dialysis for more than 6 months were selected,and the related clinical data of patients were collected.Mean blood pressure in the first 6 months of peritoneal dialysis was obtained,and baseline pulse pressure was calculated.All patients were followed up till death,cessation of peritoneal dialysis,transfer to the other centers,lost in follow-up or to the end of the study(December 31,2010).Multivariate linear regression was employed to determine the independent influencing factors of pulse pressure,and the association of pulse pressure with mortality was explored with multivariate Cox proportional hazards model.Results A total of 498 patients undergoing peritoneal dialysis were included.Multivariate linear regression revealed that age(β=2.34,P<0.001),serum albumin(β=-0.235,P=0.004) and diabetes(β=4.93,P<0.001) were independent influencing factors of pulse pressure.Univariate analysis demonstrated that pulse pressure was closely associated with all-cause death(HR=1.017,95%CI 1.007-1.027,P<0.001) and cardiovascular death(HR=1.016,95%CI 1.003-1.030,P=0.019).Multivariate Cox proportional hazards model indicated that advanced age(HR=1.065,95%CI 1.047-1.082,P<0.001),low serum albumin(HR=0.945,95%CI 0.909-0.983,P=0.005) and low hemoglobin(HR=0.981,95%CI 0.971-0.991,P<0.001) were independent risk factors of all-cause death,and advanced age(HR=1.041,95%CI 1.016-1.066,P=0.001) and low hemoglobin(HR=0.983,95%CI 0.969-0.996,P=0.014) were independent risk factors of cardiovascular death.However,pulse pressure was not an independent risk factor of all-cause death(HR=1.019,95%CI 0.996-1.043,P=0.104) and cardiovascular death(HR=0.988,95%CI 0.860-1.136,P=0.870) in the model after multivariate adjustment.Conclusion Age,serum albumin and diabetes are independent influencing factors of pulse pressure in patients undergoing peritoneal dialysis.The association of pulse pressure with mortality in patients undergoing peritoneal dialysis needs further study.