维持性腹膜透析患者血清总胆红素水平与全因死亡、心血管事件死亡的相关性

目的探讨血清总胆红素(total bilirubin,TBIL)水平与维持性腹膜透析患者全因死亡、心血管事件死亡的相关性。方法单中心、回顾性、队列研究。纳入2013年1月1日至2015年12月31日在昆明医科大学第二附属医院肾内科置管并开始腹膜透析3个月及以上患者126例。收集患者的人口学资料、基线临床及实验室检查资料。所有患者随访至2018年12月31日。按照血清TBIL二分位数水平分为两组。采用Kaplan-Meier法比较两组患者的生存率,COX回归模型分析血清TBIL与全因死亡及心血管事件死亡的相关性。对各研究因素与血清TBIL进行Spearman相关分析。结果本研究共纳入126例腹膜透析患者,患者年龄是(52.8±13.5)岁,男性83例(65.9%)。透析龄25(13,39)个月。42例患者在随访期间死亡。低血清TBIL组全因死亡率为43.1%(28/65),高血清TBIL组全因死亡率为23.0%(14/61),差异有统计学意义(P=0.017)。两组间的血清TBIL、BUN、肌酐、eGFR、磷、钙磷乘积水平差异均有统计学意义。而年龄、性别、合并高血压、收缩压、舒张压、合并糖尿病、合并心力衰竭、合并左心室肥厚、合并冠心病、合并脑血管意外、合并HBV、合并HCV、透析龄、血清白细胞、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、谷氨酰基转移酶、总胆汁酸、尿酸、铁、总胆固醇、三酰甘油、白蛋白、血糖、红细胞压积、C反应蛋白、甲状旁腺素两组间差异均无统计学意义。Kaplan-Meier生存曲线显示,血清TBIL≤5.9 mmol/L组患者的生存率明显低于TBIL5.9 mmol/L组(P=0.001)。充分校正的多因素COX回归分析显示,低血清TBIL是持续性腹膜透析患者全因死亡(HR=2.855 95%CI:1.476～5.524,P=0.002)的独立危险因素,与心血管事件死亡相关(HR=3.5011 95%CI:1.442～8.498,P=0.006)。结论 TBIL与持续不卧床腹膜透析患者的全因死亡风险及心血管死亡风险相关。     

维持性腹膜透析患者血压变异性与心血管事件发生相关性研究

目的分析维持性腹膜透析患者一周血压变异性(blood pressure variability,BPV)与主要不良心血管事件的关系。方法在南阳市中心医院腹膜透析中心2014年1月至2016年1月纳入85例透析时间大于3个月的腹膜透析患者,收集入院腹膜透析评估时的一周晨起血压以及其他临床资料,并根据中位血压变异系数,分为高BPV组(血压变异系数11.0%)与低BPV组(血压变异系数≤11.0%),随访至2017年5月,监测两组主要不良心血管事件(心血管死亡、需住院治疗的心肌梗死、心绞痛、心力衰竭、卒中)的发生情况。结果高BPV组与低BPV组透析相关指标(透析龄、Kt/V、日出液量)、原发病比例、钙磷代谢、血脂、血红蛋白及血白蛋白等指标,均无明显统计学差异。经中位随访15个月,腹膜透析患者主要不良心血管事件总发生率24.7%,其中心力衰竭发生率最高(15.3%)。高BPV组主要不良心血管事件总发生率(30.4%)高于低BPV组(17.9%),但并无统计差异(P=0.181)。腹膜透析患者无心血管事件中位存活时间30.5(27.2,33.8)个月,低BPV组无心血管事件存活时间33.9(30.1,37.8)个月高于高BPV组27.1(22.1,32.1)个月(χ~2=4.649,P0.05)。结论维持性腹膜透析患者中,一周血压变异性与无心血管事件存活时间密切相关,血压变异性越高,无心血管事件存活时间相对越短。     

腹膜透析患者血脂联素与动脉粥样硬化性疾病的关系

目的 探讨血脂联素(ADPN)与尿毒症腹膜透析(腹透)患者炎症及动脉粥样硬化 的关系。方法 采用酶联免疫复合物法测定正常对照组与59例规律性腹透患者血清ADPN水 平,并对这些腹透患者进行为期(10．0±1．7)月的随访。分析血清ADPN水平与血脂、炎症指标、 颈动脉内膜厚度、颈动脉斑块、既往心血管病(CVD)史和心血管预后的关系。结果 与正常对照 组相比,腹透组患者的血清ADPN水平显著升高[(13．09±7．54)μg／ml比(6．65±4．33)μg／ml,P= 0．001]。腹透患者血清ADPN与年龄、体重指数(BMI)、甘油三酯、C-反应蛋白(CRP)水平呈负相 关;与高密度脂蛋白(HDL)呈正相关。血清ADPN水平在有颈动脉斑块及动脉粥样硬化性心血 管疾病病史的腹透患者中较低。在随访期内有CVD事件发生组血清ADPN水平与无CVD事件 发生组相比显著降低。结论 血清ADPN水平与脂代谢异常、炎症和动脉粥样硬化性疾病有关, 血清ADPN较高的患者发生CVD事件的危险性较低。在腹透患者中,ADPN可能具有心血管的 保护作用。     

腹膜透析患者血清铁蛋白水平与微炎症及透析效果相关性分析

目的分析腹膜透析患者血清铁蛋白与C反应蛋白(CRP)之间的相关性,探讨血清铁蛋白对腹膜透析效果的影响。 方法回顾性分析2009年6月至2015年7月在广西医科大学第一附属医院腹膜透析中心规律随诊的腹膜透析患者120例,根据血清铁蛋白浓度将其分成三组,Ⅰ组：男性患者血清铁蛋白≤200 μg/L或女性患者血清铁蛋白≤150 μg/L;Ⅱ组：男性患者血清铁蛋白浓度为200～500 μg/L或女性患者150～500 μg/L;Ⅲ组：血清铁蛋白≥500 μg/L,将三组的临床资料进行分析。根据CRP值,将120例患者分为A组(CRP ≤8 mg/L)和B组(CRP > 8 mg/L),比较两组间血清铁、转铁蛋白饱和度、总铁结合力和血红蛋白水平差异。血清铁蛋白与各相应临床指标进行相关性分析。采用SPSS 16.0统计学软件进行数据分析。 结果(1)与Ⅰ组及Ⅱ组比较,Ⅲ组C反应蛋白水平显著升高,血红蛋白及Kt/V值均低于Ⅰ组及Ⅱ组(P<0.05),Ⅰ组与Ⅱ组比较无显著性差异(P>0.05)。(2)Ⅰ组总铁结合力明显高于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组与Ⅲ组比较无显著性差异(P>0.05)。(3)相关性分析提示血清铁蛋白与血红蛋白及总铁蛋白结合力呈负相关(r＝－0.194,r＝－0.298;P<0.05),与血尿素氮、年龄及C反应蛋白呈正相关(r＝0.234,r＝0.238,r＝0.203;P<0.05)。(4)与A组比较,B组患者血清铁蛋白水平显著升高(t＝2.271, P<0.05),两组间总铁结合力、转铁蛋白饱和度及血红蛋白无显著性差异(t＝0.391,t＝0.371, t＝0.835; P>0.05)。 结论腹膜透析患者血清铁蛋白水平受微炎症状态的影响,高浓度的血清铁蛋白可影响腹膜透析患者的透析充分性,应该联合年龄、转铁蛋白饱和度、血红蛋白及CRP等指标,正确的判断患者缺铁情况。     

血清FGF23联合25羟维生素D水平检测对腹膜透析患者腹主动脉血管钙化的预测价值

目的:探讨血清成纤维细胞生长因子23(FGF23)联合25羟维生素D水平检测对腹膜透析患者腹主动脉血管钙化的预测价值。方法:回顾性分析2018年05月—2020年05月医院收治的100例腹膜透析患者的临床资料,其中腹主动脉血管钙化患者(记为血管钙化组)53例,腹主动脉血管无钙化患者(记为血管无钙化组)47例。对比两组生化指标及血清FGF23、25羟维生素D水平,采用Logistic回归分析腹膜透析患者腹主动脉血管钙化的影响因素,分析血清FGF23联合25羟维生素D水平检测对腹膜透析患者腹主动脉血管钙化的预测价值。结果:血管钙化组透析龄、血肌酐(Scr)、碱性磷酸酶(ALP)、血磷、血钙水平、钙磷乘积、低密度脂蛋白胆固醇(LDLC)、质金属蛋白酶-9(MMP-9)、脂蛋白相关磷脂酶A2(LP-PLA2)、FGF23水平高于血管无钙化组(P<0.05);血管钙化组血清FGF23水平高于血管无钙化组(P<0.05),血管钙化组血清25羟维生素D水平低于血管无钙化组(P<0.05);Logistic回归分析显示钙磷乘积、LDLC、血清FGF23、25羟维生素D是腹膜透析患者腹...     

单中心腹膜透析患者贫血及铁代谢的临床分析

目的调查持续性不卧床腹膜透析患者贫血及铁代谢的情况,分析贫血与铁代谢的关系及影响因素。方法选取在我院规律随访的持续性不卧床腹膜透析患者77例进行横断面调查。排除感染、器官衰竭、恶性肿瘤、肝脏疾病及急性失血者等,记录患者临床资料,检测贫血及铁代谢相关指标。采用SPSS13．0软件进行统计学处理。结果77例患者年龄20-79岁,男、女比例为1：1．6,腹透龄3个月～10年。病因构成：原发性肾小球肾炎占66．9％,高血压肾病占16．9％,糖尿病肾脏病占9．9％,其他病因占5．8％,仍贫血者92．2％,轻度贫血占55．8％。40．3％患者存在铁缺乏,23．4％存在铁负荷,41．6％铁代谢指标达目标值。贫血程度与铁缺乏无相关关系,贫血程度与铁负荷、血肌酐及全段甲状旁腺素水平正相关。甲状旁腺素与铁缺乏正相关,年龄、贫血程度与铁负荷正相关。血钙、血白蛋白水平与铁负荷负相关。结论腹膜透析患者普遍存在不同程度贫血,铁缺乏发生率较高,铁代谢指标达标率较低,补铁应注意避免铁负荷过重。     

重视心血管合并症对腹膜透析患者预后的影响

心血管事件（缺血性心脏病、粥样硬化性心血管病等）是影响透析患者远期生存率的重要因素之一。有人将此类病变统称为粥样硬化性心血管疾病（atherosclerotic cardiovascular disease,ASCVD）。传统观念认为腹膜透析（PD）患者无须动静脉（A-V）造瘘,从而减少A—V短路所引起的体循环压力增高;其次,PD时体内容量变化持续缓慢进行,这种稳定的容量变化有利于减少ASCVD的发生。     

腹膜透析患者血清白蛋白与体液负荷的关系

目的:血清白蛋白是影响透析患者预后的重要危险因素之一,而且与新发生及复发的心血管并发症及死亡率关系密切。近年发现低白蛋白血症可能更多与容量负荷过度及炎症等有关。因此,拟对腹膜透析患者中血清白蛋白与体液负荷的关系进行分析。方法:对CAPD患者,实行限制水钠摄入治疗2个月,测定患者治疗前后的体重、容量指标及血清白蛋白水平,收集患者治疗前后血压、24h尿量和超滤量等相关资料。结果:CAPD患者35例。经严格的控制水钠摄入治疗后,有26名患者体重明显减轻,从(62.2±8.8)kg减至(60.2±8.2)kg(P=0.000),细胞外液(ECW)从(16.23±2.95)L降至(14.96±2.64)L(P=0.000),而血清白蛋白水平则从(34.9±3.5)g/L升高到(37.3±3.7)g/L(P=0.003),患者自我感觉明显改善;9名患者体重无改善,平均增加(1.1±1.1)kg,ECW增加(0.68±1.28)L,血清白蛋白降低(2.1±2.3)g/L;所有患者24小时尿量和超滤量没有统计学意义上的差别。血清白蛋白变化与各项容量指标的变化间均存在线性相关(P<0.05)。结论:血清白蛋白的变化与患者体液状况的变化显著负相关。严格控制患者的水钠摄入是控制患者容量负荷过多、提高血清白蛋白水平的有效方法,患者对水钠控制的依从性将影响治疗的效果。     

腹膜透析患者血清脂肪酸结合蛋白4水平与腹主动脉钙化的关系

目的 探讨腹膜透析(peritoneal dialysis, PD)患者血清脂肪酸结合蛋白4(fatty acid binding protein-4,FABP-4)水平与腹主动脉钙化(abdominal aorta calcification, AAC)的关系。方法 纳入2020年1月至2022年1月东南大学医学院附属江阴市人民医院行PD治疗的患者共108例为研究对象,男58例,女50例,年龄范围48～72岁,年龄(57.2±4.9)岁。根据血清FABP-4中位值分为低FABP-4组和高FABP-4组,根据AAC积分,分为无和轻度钙化组(0～4分)和中重度钙化组(>4分)。结果 108例PD患者血清FABP-4水平为148.6(114.6,178.9)μg/L,其中低FABP-4组54例(<148.6μg/L)和高FABP-4组54例(≥148.6μg/L)。单因素比较发现,高FABP-4组比低FABP-4组透析龄长、尿素清除率降低,血清超敏C反应蛋白(high-sensitivity c-reactive protein, hs-CRP)、肌酐、全段甲状旁腺激素(int...     

Relationship between serum magnesium level and coronary artery calcification in maintenance hemodialysis patients

Objective To evaluate the relationship between serum magnesium and coronary artery calcification (CAC) and their associated factors. Methods 131 patients with chronic kidney disease on regular hemodialysis (HD) were recruited into this study from December 2014 to December 2015 in our center. Demographic and clinical data of selected patients were collected. Serum fibroblast growth factor 23 (FGF-23) level was quantified by enzyme linked immunosorbent assay(ELISA). Quantification of coronary artery calcification score (CACs) was determined by multi-slice spiral computed tomography (MSCT). The relationships between serum magnesium and FGF-23 level, CACs, demographic and clinical data were investigated. Results Patients were divided into low serum magnesium group, normal serum magnesium group and high serum magnesium group according to their serum magnesium levels. There were significant differences in the distribution of diabetes history, serum phosphorus, serum albumin, serum pre albumin, serum uric acid among these three groups(P＜0.05). A significant positive correlation was confirmed between serum magnesium level and serum albumin, serum pre albumin, serum phosphorus and serum uric acid by Pearson correlation analysis and Spearman correlation analysis (r=0.389, 0.234, 0.200, 0.234, P=0.000, 0.007, 0.022, 0.007, respectively). According to the degree of CAC, all maintenance hemodialysis (MHD) patients were divided into non-calcification group, low calcification group, moderate calcification group and high calcification group, and there were significant differences in the distribution of the age, serum phosphorus, serum magnesium, FGF-23 levels among these groups (P＜0.05) . Spearman correlation analysis showed that CACs was positively correlated with age, FGF-23, serum phosphorus (r=0.309, 0.277, 0.180, P=0.000, 0.001, 0.040, respectively), while negatively correlated with serum magnesium level (r=-0.238, P=0.006) in patients with MHD. The independent risk factors of CACs were aging, high level of FGF-23 in MHD patients by using ordinal logistic regression. However, Hypermagnesemia was a protective factor. Conclusions The history of diabetes, low serum albumin, phosphorus metabolism disorder and CAC are associated with hypomagnesemia in MHD patients. In MHD patients, aging as well as high level of FGF-23 are the risk factors of CAC, and hypermagnesemia is a protective factor of CAC.     

Associations of low serum total bilirubin level with all-cause mortality and cardiovascular mortality in peritoneal dialysis patients

Objective To investigate the association of low serum total bilirubin (TBIL) level with all-cause mortality and cardiovascular mortality in peritoneal dialysis patients. Methods As a single-center, retrospective, cohort study, all the patients who underwent peritoneal dialysis catheterization in the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University and started peritoneal dialysis for more than 3 months from January 1, 2006 to December 31, 2010 were included. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until December 31, 2012. Patients were divided into 4 groups according to their baseline serum TBIL levels (interquartile range). Kaplan-Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of TBIL with all-cause mortality and cardiovascular mortality. Logistic regression was used to analyze the influencing factors of low TBIL level. Results A total of 880 peritoneal dialysis patients with baseline TBIL data were enrolled in this study, with age of (48.0±15.4) years old, among whom 59.0% were male. Median TBIL was 4.5 μmol/L and interquartile range was 3.4-5.8 μmol/L. The comparison between TBIL quartile groups showed that the difference in proportion of diabetics, Charlson comorbidity index, hemoglobin, serum albumin, serum calcium, intact parathyroid hormone, urea nitrogen, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was statistically significant (all P＜0.05), while the difference in body mass index (BMI), estimated glomerular filtration rate, serum creatinine, urea nitrogen, uric acid and phosphorus was not statistically significant. After a median follow-up of 31 months, 194 patients died, 104 of which were cardiovascular deaths. Kaplan-Meier curves showed higher all-cause mortality in patients with TBIL≤3.4 μmol/L (Q1 group) (P=0.032) and there was no statistical difference in the cardiovascular mortality among different groups. After adjusting for biochemical indicators such as demographics, comorbidities, and liver function, taking baseline TBIL Q2 level (3.4＜TBIL≤4.5 μmol/L) as a reference, the hazard ratio for all-cause death in patients with TBIL≤3.4 μmol/L was 1.702 (95%CI 1.093-2.650, P=0.019), and the hazard ratio for cardiovascular death was 1.760 (95%CI 0.960-3.227, P=0.068). Multiple logistic regression analysis results showed that diabetes (OR=1.065, 95%CI 1.010-1.122, P=0.019) and high BMI (OR=1.838, 95%CI 1.056-3.197, P=0.031) were risk factors for baseline serum TBIL≤3.4 μmol/L. However, high hemoglobin (OR=0.990, 95%CI 0.982-0.998, P=0.011), high serum albumin (OR=0.950, 95%CI 0.916-0.985, P=0.006) and high ALT (OR=0.998, 95%CI 0.976-0.999, P=0.036) were the protective factors for patients with baseline serum TBIL≤3.4 μmol/L. Conclusion Baseline serum TBIL≤3.4 μmol/L in peritoneal dialysis patients is independently associated with all-cause mortality, and is not significantly associated with cardiovascular mortality; and baseline serum TBIL≤3.4 μmol/L occurred is associated with diabetes, high body mass index, low levels of hemoglobin, serum albumin and ALT.     

Association between metabolic syndrome and prognosis in patients with peritoneal dialysis

Objective To investigate the incidence situation of metabolic syndrome (MS) in patients with continuous ambulatory peritoneal dialysis (CAPD), and analyze the correlation between MS and prognosis of patients. Methods The patients who received peritoneal dialysis from June 1, 2002 to April 30, 2018 and followed up regularly were divided into MS group and non-MS group according to the diagnostic criteria of MS. Follow-up was until July 31, 2018. The differences of clinical data, metabolic indexes and clinical outcomes between the two groups were compared. The survival rates of the two groups were compared by Kaplan-Meier survival curve, and the risk factors of all-cause death and cardiovascular disease (CVD) death were analyzed by Cox regression analysis. Results A total of 516 patients with CAPD were enrolled in this study, including 340 males (65.9%) and 176 females (34.1%). Their age was (47.29±12.20) years. The median follow-up time was 20 (9, 39) months. According to the diagnostic criteria of MS, the patients were divided into MS group (210 cases, 40.7%) and non-MS group (306 cases, 59.3%). At baseline, there was no significant difference in age, educational background, duration of peritoneal dialysis, smoking history and drinking history between the two groups (P＞0.05), but the patients in MS group were more exposed to high glucose peritoneal dialysate (P＜0.05). The body mass index (BMI), blood phosphorus, blood glucose, blood potassium, triglyceride, cholesterol and systolic blood pressure in MS group were significantly higher than those in non-MS group (all P＜0.05), and HDL-C level was significantly lower in MS group than in non-MS group (P＜0.05). There were no significant differences in other indicators between the two groups (P＞0.05). Kaplan-Meier survival curve showed that the cumulative survival rate in MS group was significantly lower than that in non-MS group, and the difference was statistically significant (Log-rank χ2=14.87, P＜0.001). If CVD death was taken as the end event, the cumulative survival rate in the non-MS group was significantly higher than that in the MS group (Log-rank χ2=14.49, P＜0.001). Multivariate Cox regression analysis showed that MS and high 4 h dialysate creatinine/serum creatinine ratio (4hD/Pcr) were independent risk factor for all-cause death (HR=1.982, 95%CI 1.240-3.168, P=0.004; HR=3.855, 95%CI 1.306-11.381, P=0.015) and CVD death (HR=2.499, 95%CI 1.444-4.324, P=0.001; HR=5.799, 95%CI 1.658-20.278, P=0.006) in patients with CAPD. Conclusion The prevalence of MS in patients with CAPD is high, and MS and high 4hD/Pcr are independent risk factor for all-cause and CVD death in CAPD patients. They can be used as valuable indicators to predict the treatment outcomes and long-term prognosis of patients with CAPD.     

Association of serum magnesium with cardiovascular mortality and all-cause mortality in peritoneal dialysis patients

Objective To investigate the association of serum magnesium with cardiovascular disease (CVD) and all-cause mortality in peritoneal dialysis patients. Methods A retrospective study was performed in patients who initiated peritoneal dialysis from January 1, 2013 to July 31, 2019 in the Shaoxing People's Hospital. According to the standard of serum magnesium, the patients were divided into control group (Mg≥0.7 mmol/L) and low-magnesium group (Mg﹤0.7 mmol/L). The differences in baseline biochemical variables, comorbidities, medications, and clinical outcomes between the two groups were compared. Logistic regression was used to analyze the related factors of hypomagnesemia. Kaplan-Meier survival analysis and Fine-Gray model were used to compare the difference in cumulative survival rate between the two groups. Cox regression model and competitive risk model were used to analyze the risk factors of all-cause mortality and CVD mortality. Results A total of 381 peritoneal dialysis patients were enrolled in this study. Among them, 321 patients were in control group and 60 patients in low-magnesium group. The total median follow-up time was 27(15, 43) months. There were significant differences in serum albumin, magnesium, phosphorus, intact parathyroid hormone, low-density lipoprotein chloesterol, high sensitivity C-reactive protein and 4-hour dialysate-to-plasma creatinine (4 h D/Pcr) between the two groups. CVD was the main cause of death in patients on peritoneal dialysis. Multivariate logistic regression analysis showed that hypoalbuminemia (OR=0.901, 95%CI 0.831-0.976, P=0.011), hypophosphatemia (OR=0.217, 95%CI 0.080-0.591, P=0.003), higher hsCRP (OR=1.276, 95%CI 1.066-1.528, P=0.008), and higher 4 h D/Pcr (OR=1.395, 95%CI 1.014-1.919, P=0.041) were independent risk factors for patients with hypomagnesemia. Kaplan-Meier survival curve analysis showed the cumulative survival rate of patients in low-magnesium group was significantly lower than that of control group (Log-rank χ2=5.388, P=0.020). Fine-Gray model analysis showed the cumulative CVD survival rate of low-magnesium group was significantly lower than that of control group (Gray=6.915, P=0.009). Multivariate-corrected Cox regression model and competitive risk model analysis showed that higher serum magnesium level was a protective factor for all-cause mortality and CVD mortality when serum magnesium was used as a continuous variable (HR=0.137, 95%CI 0.020-0.946, P=0.044; SHR=0.037, 95%CI 0.002-0.636, P=0.023, respectively). Hypomagnesemia was an independent risk factor for all-cause mortality and CVD mortality when serum magnesium was used as categorical variable (HR=1.864, 95%CI 1.044-3.328, P=0.035; SHR=2.117, 95%CI 1.147-3.679, P=0.029, respectively). Conclusions Hypomagnesemia is susceptible to peritoneal dialysis patients with hypoalbuminemia, hypophosphatemia, higher hsCRP and higher peritoneal transport characteristics. Hypomagnesemia is an independent risk factor for CVD mortality and all-cause mortality in peritoneal dialysis patients.     

Relationship between serum 25-hydroxycholecalciferol deficiency and the risk of peritoneal dialysis associated peritonitis

Objective To investigate the relationship between serum 25-hydroxycholecalciferol[25(OH)D3] deficiency and the risk of peritoneal dialysis associated peritonitis. Methods Baseline clinical data (before the peritoneal dialysis catheter insertion) of peritoneal dialysis patients treated with CAPD in the First Affiliated Hospital of Guangxi Medical University from May 1, 2013 to February 1, 2016 were retrospective analyzed. All the patients were followed-up until July 31, 2016. According to the baseline serum 25(OH)D3 levels, patients were divided into deficiency group (25(OH)D3＜15 ng/ml) and non deficiency group (25(OH)D3 ≥15 ng/ml), the baseline clinical data of the two groups were also analyzed. Kaplan-Meier method was used to compare the time-to-peritonitis of two groups. Cox proportional hazard model was used to analyze the relationship between the 25(OH)D3 deficiency and the risk of peritonitis. ROC curve was used to analyze the predictive value of the baseline serum 25(OH)D3 for the risk of PDAP in peritoneal dialysis patients. Results Compared with the 25(OH)D3 non deficiency group, 25(OH)D3 deficiency group had a significant increase incidence of peritonitis, high diastolic blood pressure and mean arterial pressure, but serum albumin, total serum protein decreased significantly (P＜0.05). Kaplan-Meier survival analysis showed that, compared with 25(OH)D3 non deficiency group, the time-to-peritonitis episode of patients with 25(OH)D3 deficiency were shorter (P＜0.05). Cox proportional hazard model showed that after adjusting for age, sex, hemoglobin, serum albumin, C-reactive protein, total Kt/V, eGFR, diabetes or not, 25(OH)D3 deficiency is the independent risk factor of peritoneal dialysis associated peritonitis (HR 5.247, 95%CI 1.180-23.340, P＜0.05). ROC curve showed the area under the curve that baseline serum 25(OH)D3 deficiency predict the occurrence of PDAP was 0.714, and the best cut-off point of baseline serum 25(OH)D3 was 11.35 ng/ml (sensitivity 75%, specificity 63%). Conclusions Peritoneal dialysis associated peritonitis occurred earlier in peritoneal dialysis patients whose baseline serum 25(OH)D3 deficiency. Baseline serum 25(OH)D3 deficiency is the independent risk factor of peritoneal dialysis associated peritonitis, which may predict the incidence of peritoneal dialysis associated peritonitis.     

腹主动脉钙化评分预测腹膜透析患者心脑血管预后的价值

【目的】 探讨腹主动脉钙化评分(abdominal aortic calcification score,AACS)与腹膜透析患者心脑血管预后的关系。方法 研究对象来自2011年7月至2014年7月期间在上海交通大学医学院附属仁济医院接受规律腹透治疗的患者。采用腹部侧位X线摄片评估所有入选者腹主动脉钙化程度,并根据Kauppila评分系统行AACS评分。根据AACS三分位数将患者分为无钙化组(AACS=0)、轻中度钙化组(0相似文献   

终末期肾病患者心血管事件与血清胎球蛋白A及冠脉钙化的关系

目的探讨终末期肾病（ESRD）患者心血管事件发生与血清胎球蛋白A及冠脉钙化的关系。方法对38例ESRD初始血液透析患者进行血清胎球蛋白A及相关因素检测，对其中的29例患者进行冠状动脉多层螺旋CT钙化评价研究。所有38例患者随访时间为18个月。22例非ESRD慢性肾脏病（CKDⅡ～Ⅲ期）患者人选对照组。结果38例ESRD初始透析患者在18个月随访期内出现心血管事件30例次，因心血管事件死亡者6例，占15．79％，而非ESRD患者心血管事件仅3例次（P〈0．01）且无一例死亡（P〈0．05）。ESRD血清低胎球蛋白A组心血管事件显著高于ESRD血清高胎球蛋白A组（P〈0．01）。多元逐步回归分析显示，心血管事件与血清胎球蛋白A（P〈0．01）、C反应蛋白（CRP）（P=0．0014）及低密度脂蛋白C（LDL-C）（P=0．008）密切相关。18／29例（62．07％）有冠状动脉钙化。冠状动脉钙化患者心血管事件比无冠状动脉钙化患者显著增多（P〈0．01）。冠脉钙化的ESRD患者血清胎球蛋白A水平较无冠脉钙化的ESRD患者明显下降（P〈0．01）。冠脉钙化与胎球蛋白A下降及高血磷有关（P〈0．01，P〈0．01）。结论ESRD透析患者心血管事件和（或）心血管事件死亡可能与血清胎球蛋白A下降及冠状动脉钙化有关。     

Effects of serum uric acid level on all-cause death and cardiovascular death in patients of maintaining peritoneal dialysis

Objective To investigate the effects of serum uric acid (SUA) on all-cause death and cardiovascular death in patients of maintaining peritoneal dialysis (PD). Methods One thousand and sixty-three PD patients in the First Affiliated Hospital of Zhejiang University Medical College were included. The SUA levels at 6 months after PD start were measured. Patients with SUA≥420 μmol/L were grouped in hyperuricemia group (492 cases) and patients with SUA＜420 μmol/L were grouped in normal uric acid group (571 cases). The effects on all-cause mortality and cardiovascular mortality were retrospectively analyzed. Results The median age of the patients was 51(41, 62) years; 557 cases were male (52.40%); the median follow-up time was 33(20, 54) months (6-96 months); 167 cases (15.71%) died during the follow-up period, including 64 cases (6.02%) with cardiovascular causes. The mortality in hyperuricemia group was 19.11%(94/492) and the cardiovascular mortality was 7.93%(39/492), both rates were higher than those in normal uric acid group, and the differences were statistically significant (P=0.005, P=0.015, respectively). Hyperuricemia (SUA≥420 μmol/L) at 6 months after PD start (HR=1.572, 95%CI 1.155-2.141, P=0.004), high uric acid level (continuous variable) at 6 months after PD start (HR=1.002, 95%CI 1.001-1.004, P=0.008), and age≥65 years (HR=3.571, 95%CI 2.556-4.990, P＜0.001), serum albumin≤30 g/L (HR=1.907, 95%CI 1.278-2.845, P=0.002), high Charlson comorbidity index (HR=1.209, 95%CI 1.032-1.417, P=0.019) at the beginning of PD start were independent risk factors for all-causes death in PD patients. Hyperuricemia (SUA≥420 μmol/L) at 6 months after PD start (HR=1.734, 95%CI 1.033-2.912, P=0.037) and age≥65 years (HR=1.761, 95%CI 1.024-3.209, P=0.041), with diabetes (HR=2.775, 95%CI 1.358-5.671, P=0.005) at the beginning of PD start were independent risk factors for cardiovascular death in PD patients. Conclusions SUA at 6 months after PD is an independent risk factor for all-cause death and cardiovascular death in PD patients.     

Association of vascular calcification,fetuin A,C - reaction protein and the influence on cardiovascular events in peritoneal dialysis patients

ObjectiveTo investigate the association of vascular calcification, fetuin A and C- reaction protein (CRP), and explore the influence on cardiovascular events. MethodsSixty peritoneal dialysis (PD) patients were enrolled in this study. Carotid intima-media thickness (cIMT), fetuin A and CRP, along with the other serum related parameters were detected to find out their influence on vascular calcification in PD patients. The relationship between cIMT, fetuin A, CPR and cardiovascular events was analyzed in PD patients with 18 months followed-up. ResultsOf the 60 PD patients, carotid intima-media thickness (cIMT) was increased in 38 patients(63.3%). Compared with the non-increased cIMT patients, serum fetuin A concentration was significantly decreased(P＜0.05), CRP(P＜0.01) and calcium × phosphate products(P＜0.05) were significantly increased in the high - increased cIMT group. Compared with the low - increased cIMT patients, fetuin A concentration was obviously lower(P＜0.05) and calcium×phosphate products were obviously higher(P＜0.05) in the high- increased cIMT group. Linear regression analysis discovered an obvious negative correlation between CRP and fetuin A(R 2＝0.629,F ＝47.522, P＜0.01) , as well as fetuin A and calcium×phosphate products (R 2＝0.299, F ＝11.948, P＝0.002). Multiple regression analysis indicated that fetuin A was independently negatively correlated with cIMT(B ＝-0.019,t ＝-6.042, P＜0.01). At 18 months, there were 36 newly - happened cardiovascular events and among which 6 cases died. Logistic regression analysis found that increased cIMT was risk factor to cardiovascular events in PD patients(OR ＝3.691， 95%CI 1.467-9.258，P＝0.006). ConclusionDecreased fetuin A and increased calcium×phosphate products deteriorate carotid calcification in PD patients. Micro-inflammation of PD patients represented by high CRP levels may increase calcium×phosphate products by depressing the fetuin A level, and in the end will stimulate carotid calcification. Increased cIMT is a risk factor for cardiovascular events.