老年腹膜透析患者相关危险因素的分析

目的：探讨老年腹膜透析患者的相关危险因素。方法：通过观察分析危险因素：性别、原发病情况（糖尿病、高血压）、营养状态指标、贫血指标、腹膜透析充分性指标、钙磷代谢情况,并分析腹膜透析患者相关性感染及其心脑血管并发症情况。结果：高血糖、腹膜透析充分性（总Kt/V和总Ccr）及血浆白蛋白（Alb）成为腹膜透析患者老年组独立影响危险因素;另外,31例患者中有2例患者出现腹膜透析相关性腹膜炎情况,1例患者出现严重的脑血管并发症。结论：积极控制老年腹膜透析患者的血糖,并改善患者血清白蛋白及正确评估老年腹膜透析患者的透析充分性,这对于提高老年腹膜透析的生存质量具有重要作用。     

尿毒症患者腹膜透析置管用导丝的临床研究

目的 比较腹膜透析置管术用涂层金属导丝在临床使用上的作用和意义,以利于腹膜透析的开展.方法 对行腹膜透析置管术的95例慢性肾功能衰竭尿毒症期的患者,根据其所使用的导丝类型不同,将病人分为普通导丝对照组(69例)和涂层导丝观察组(26例)两组,统计其腹膜炎发病率并进行比较.结果 置管术后进行腹膜透析,两组患者发生腹膜炎的...     

腹膜透析患者退出因素分析

目的 寻找终末期肾衰竭患者退出腹膜透析(peritoneal dialysis,PD)的高危因素,为提高腹膜透析患者技术生存率提供依据.方法 以2008年1月至2013年12月本院腹膜透析患者共计196例为研究对象,分为退出组和对照组.退出腹膜透析患者为退出组,未退出腹膜透析患者为对照组.回顾性分析患者的社会状况、一般资料、临床资料等相关指标,如换液操作者、工作状态、残余尿量、血肌酐水平等,应用单因素、多因素Logistic回归分析进行统计学分析.结果 退出组共纳入54例,对照组共纳入142例,退出率为27.6％.单因素分析得出,腹透患者的居住地、文化程度、工作状态、换液操作者、残余尿量、血肌酐及eGFR水平对患者的退出有影响;多因素Logistic分析提示工作状态、换液操作者、残余尿量、血肌酐水平是患者退出的高危因素;其中,残余尿量与退出风险呈负相关,血肌酐水平与退出风险呈正相关.结论 本院PD患者退出率高的原因主要与患者开始行PD的时间太晚,残余肾功能较差有关.应加强患者教育,适时开始PD,鼓励患者参加工作,本人进行换液操作.     

单中心腹膜透析患者的转归及其危险因素分析

目的分析山西医科大学第二医院腹膜透析中心腹透患者的临床资料,探讨腹透患者的转归及其危险因素。方法采用回顾性研究的方法,收集选取山西医科大学第二医院腹膜透析中心2009年1月至2019年6月期间维持性腹膜透析患者的临床资料,采用卡方检验和log rank检验进行单因素分析,采用多元逐步COX回归模型进行多因素分析,讨论腹膜透析患者的不良转归及其危险因素。结果 258例维持性腹透患者,原发病中慢性肾小球肾炎占42.2%,糖尿病肾病占32.9%;退出腹膜透析97例,退出率37.60%;退出腹膜透析患者中转血液透析者49例,占19.0%;死亡39例,占15.1%;肾移植4例,占退出的1.6%;失访5例。经单因素及多因素分析,合并心脑血管疾病(HR=2.599,95%CI:1.340～5.043,P=0.005)、24 h尿量小于400 mL(HR=0.207,95%CI:0.085～0.501,P0.001)、肌酐小于707μmol/L(HR=3.259,95%CI:1.682～6.316,P0.001)是腹膜透析患者死亡的独立危险因素。腹膜炎的发生(HR=3.548,95%CI:1.882～6.691,P0.001)、中性粒细胞百分比大于70%(HR=0.543,95%CI:0.302～0.977,P=0.042)、尿酸大于360μmol/L(HR=0.352,95%CI:0.168～0.735,P=0.005)、总胆固醇大于5.7 mmol/L(HR=0.368,95%CI:0.160～0.931,P=0.034)是腹膜透析患者转血液透析的独立危险因素。结论我中心退出腹膜透析患者的转归主要为死亡及转血液透析。合并心脑血管疾病、24 h尿量小于400 mL、肌酐小于707μmol/L是腹透患者死亡的独立危险因素;腹膜炎的发生、中性粒细胞百分比大于70%、尿酸大于360μmol/L、总胆固醇大于5.7 mmol/L是腹透患者转血液透析的独立危险因素。     

腹膜透析患者骨代谢与骨质疏松、腹主动脉钙化的相关性

目的 探讨在腹膜透析（peritoneal dialysis,PD）患者中骨代谢标志物与骨质疏松（osteoporosis,OP）、腹主动脉钙化（abdominal aortic calcification,AAC）的关系。方法 入组腹膜透析患者80例,根据双能X线骨密度仪测量结果分为骨质疏松组和非骨质疏松组。拍摄侧位X线片以评估腹主动脉钙化情况,根据AAC评分（AACS）将其分为三组：无钙化、轻度和中重度钙化。收集所有患者的临床数据、生化指标、骨代谢指标和骨密度（bone mineral density,BMD）,对AACS、OP的影响因素进行分析。结果 腹膜透析患者中骨质疏松组AACS、CRP、血磷（P）、β-CTX显著高于非骨质疏松组（P＜0.05）。 AACS三组间年龄、CRP、BNP、血磷、钙磷乘积（CPP）、β-CTX、PTH、腰椎骨密度比较,差异具有统计学意义（P＜0.05）。Spearman相关性分析显示AACS与年龄、透析龄、体质量指数、CRP、BNP、空腹血糖、β-CTX、PTH呈正相关（P＜0.05）;与腰椎骨密度呈负相关（r=-0.294,P＜0.01）。以AACS是否≥5分作为因变量,采用二元Logistic回归分析显示（矫正混杂因素后）,年龄、CPP、β-CTX是其独立危险因素。以腹膜透析患者是否并发骨质疏松为因变量,Logistic回归分析发现β-CTX是其独立危险因素。结论 在腹膜透析患者中,β-CTX可以作为监测AAC严重程度,预测骨质疏松发生的指标。     

肥胖尿毒症患者腹膜透析情况分析

肥胖症的发病率逐年上升，而尿毒症患者中，肥胖患者也越来越多。为此回顾性分析2000年1月至2005年12月我科行腹膜透析的肥胖尿毒症患者的临床资料，以了解肥胖尿毒症患者腹膜透析效果。     

腹膜透析治疗尿毒症心肌病的临床研究

目的:明确尿毒症心肌病的致病因素,控制其发生或发展,减少尿毒症心肌病的发病率,提高尿毒症患者的生存质量.方法:以腹膜透析为基础,观察治疗前后肾功能、左心功能、左心结构变化.结果:腹膜透析治疗尿毒症心肌病,治疗后左心功能、左心结构、临床症状均有明确改善.结论:腹膜透析可以更好地保存终末期肾病(ESRD)患者残存肾功能,减少心脏等严重并发症,提高患者生活质量.     

腹膜透析患者透析充分性的临床研究

目的：评估腹膜透析患者充分透析的透析剂量。方法：以主观全面营养评价（ＳＧＡ）评分和血清白蛋白浓度为标准,对５８例腹膜透析患者作营养评价,并分析ＳＧＡ评分,血清白蛋白浓度与患者的透析剂量之间的关系。     

维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及危险因素分析

目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例（8.3％）患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0％（8/16）.治愈12例（75.0％）,死亡1例.高龄（OR=1.35,95％ CI 1.16～7.68,P=0.026）、糖尿病（OR =3.34,95％ CI 1.90～6.54,P＜0.001）、低血红蛋白（OR=1.68,95％ CI 1.21～6.48,P=0.022）及低白蛋白血症（OR=1.04,95％ CI1.02～1.07,P=0.036）是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.     

腹腔镜手术在尿毒症患者腹膜透析治疗中的应用

目的 探讨腹腔镜手术在尿毒症患者腹膜透析治疗中的应用价值.方法 2007年9月～2011年5月对16例未腹透的尿毒症患者采用腹腔镜下置管.气腹后,观察全腹腔,先将腹透管置于腹腔,末端固定于腹腔底部,然后将腹透管由旁侧5 mm插管处引出,使内涤纶套刚好在腹膜外,无须荷包缝合,术后自行生长闭合.同时对手术粘连、疝、卵巢囊肿或较多的大网膜予以相应处理.同期对6例已腹透的患者反复引流不畅判定有大网膜包裹,腹腔镜下行超声刀切除,并固定末端.结果 16例首次置管的手术操作时间平均26.8 min（25～40 min）,6例大网膜包裹手术操作时间平均38.6 min（30～46 min）.术后1 d内排气,肠功能恢复满意.无腹腔脏器损伤、腹膜炎等并发症发生.首次置管者16例随访2年,均未发生大网膜包裹,未发生漂移;6例大网膜包裹随访2年,均未发生再次大网膜包裹,未发生漂移,无渗漏.结论 腹腔镜手术内固定有效防止漂管,对清除已包裹透析管的大网膜和预防包裹有良好效果,但由于无荷包缝合容易出现渗漏,需要进一步完善手术方法.     

腹膜透析患者成纤维细胞生长因子23与骨代谢的关系

目的 探讨腹膜透析患者成纤维细胞生长因子23（FGF-23）与钙磷代谢及骨密度的关系。 方法 研究对象为中南大学湘雅医院持续性不卧床腹膜透析（CAPD）患者59例,按照世界卫生组织骨密度评分标准将CAPD患者分为骨质正常、骨质降低、骨质疏松3组,另设健康对照组30例。酶联免疫吸附法检测FGF-23、1,25（OH）2VitD3;免疫化学发光法检测甲状旁腺激素（PTH）;自动生化分析仪测量血钙（Ca）、磷（P）;双能X射线吸收仪测量骨密度（BMD）。 结果 CAPD患者股骨颈部位的骨质疏松率为23.7%,腰椎部位的骨质疏松率为35.6%。3组间FGF-23水平差异无统计学意义,但CAPD组FGF-23水平显著高于健康对照组（P ＜ 0.01）。Pearson相关分析显示log[FGF-23]与血磷呈正相关（r = 0.604,P ＜ 0.01）;与肾小球滤过率（GFR）、1,25（OH）2VitD3呈负相关（r = -0.651,P ＜ 0.01;r = -0.401,P ＜ 0.05）;与 PTH、Ca、T值、透析龄无相关。 结论 CAPD患者血FGF-23显著增高,血磷、肾功能状态、1,25（OH）2VitD3均可调节血FGF-23水平,但FGF-23与骨密度降低无直接关系。     

Fatigue in chronic peritoneal dialysis patients

Fatigue is a common complaint in long termdialysis patients that may influence theirquality of life. The present study was carriedout in order to evaluate the prevalence andcourse of fatigue in a group of chronic PDpatients and to find the possible factor(s)related to its development. We retrospectivelyreviewed 100 charts of the patients previouslyon PD. The presence or absence of fatigue inthe 1st and last clinic visits and the 1st and2nd changes in fatigue state were studiedaccording to the monthly clinical records ofthe primary nurses. Data regarding dialysatevolume, urine volume, weekly erythropoietin(EPO) dose, hemoglobin, hematocrit, blood urea,serum creatinine, residual renal creatinine andurea clearances, dialysate to peritonealcreatinine ratio (D/P Cr), total weekly Kt/Vand total creatinine clearance/l.73 m² bodysurface area (TCrCl) were collected. Fifty-fivepatients were male and 45 female. The mean ageat the 1st clinic visit was 61.3 ± 16 years.At the 1st visit 55 patients had fatigue and 45did not. In 32 of the 55 patients fatiguedisappeared after a mean duration of 7.9 ± 8.4months and in 31 of the 45 patients fatigueappeared after a mean duration of 8 ± 6.8months. So at the last visit the frequency offatigue increased significantly from 55% to67% (p < 0.001). In patients with fatigue themean age and female percentage were higher(64.2 ± 14.1 vs 57.8 ± 17.6, p = 0.05 and 1.2vs 0.5, p < 0.05 respectively), mean hemoglobinconcentration was lower (104.4 ± 14.7 vs110.6 ± 14.2 g/L, p < 0.04) and mean EPO dosewas higher (6379.6 ± 7142 vs 3395.4 ± 4337.8units/week, p < 0.02) at the 1st clinic visit.EPO dose was also higher in patients withfatigue at the last visit (8253.7 ± 10317.3units/wk vs 4736.4 ± 5432.5, p < 0.03). Nocorrelation was found between dialysis adequacyaccording to either weekly Kt/V or TCrCl andnutritional state according to nPCR andfrequency of fatigue. We conclude that fatigueis a common symptom in PD patients and it'sprevalence increases over time. Anemia seemsto be the most important factor associated withfatigue. Dialysis adequacy and nutritionalstate did not show any correlation with thefrequency of fatigue in our study.     

黄芪改善腹透患者腹腔巨噬细胞功能的临床研究

目的：研究黄芪对尿毒症患腹腔巨噬细胞功能的影响。方法：对43例尿毒症初始行腹膜透析的患在腹透液中不加（对照组）和加入黄芪注射液（用药组）治疗1周,用ELISA法检测观察前后腹腔巨噬细胞分泌TNF－a能力和吞噬功能的变化。结果：黄芪用药组腹腔巨噬细胞吞菌率、吞噬指数、杀菌率和巨噬细胞分泌TNF－a水平和对照组相比均明显上升（P＜0．01）,巨噬细胞分泌TNF－a水平与用药前自身对比也显提高（P＜0．05）。结论：腹透液中加入黄芪注射液可提高腹透患腹腔巨噬细胞功能。     

维持性血液透析及腹膜透析患者骨密度的评估

目的了解我院MHD及PD患者BMD状况,探讨BMD与临床资料、骨代谢指标及生化指标的相关性及危险因素分析。方法选择我院住院及门诊随访的MHD及PD患者,透析龄均超过3个月,收集患者临床资料及血尿标本。采用超声骨密度仪检测患者BMD状况,对骨量异常患者的BMD及患者一般临床及实验室资料进行相关性分析,并进一步分析透析患者骨量异常的危险因素。采用SPSS19.0软件包进行数据统计及分析。结果 MHD组及PD组骨量异常发生率分别为57.98%,48.54%,有显著统计学差异;随着透析龄的延长,透析患者BMD下降,透析龄3年以上的PD患者比MHD患者的TScore值相对较高,两组间也存在统计学差异。高龄、高透析龄、高BMI、高血磷及高ALP血症是透析患者发生骨量异常的危险因素。结论 MHD患者比PD患者更易发生骨量异常,且随着透析龄的延长,透析患者骨量异常发生率增高,高龄、高透析龄、高BMI、高血磷及高ALP血症是透析患者发生骨量异常的危险因素。     

骨质疏松症患者的牙周组织检查

骨质疏松症和牙周炎均为中老年人的多发病，并都有骨的吸收破坏，骨量减少。为了阐明两者的关系，本研究对２９例中重度骨质疏松症患者和２５例骨密度正常者的牙周状况进行了检查与对比。结果表明：骨质疏松症患者和骨密度正常者的牙周炎患病率无明显差别，表明骨质疏松症与牙周炎之间无明显的相关关系。根据本研究结果提示：骨质疏松症在牙周炎的发生上并不起主要作用，局部（菌斑诱导的非特异性炎症）因素比全身因素在牙周炎的发病机理中更为重要。     

快速腹膜平衡试验215例结果分析

目的分析215例快速腹膜平衡试验的结果,并与其他腹膜透析中心结果比较。方法对215例腹膜透析患者行快速腹膜平衡试验,据Twardowski分组标准将患者分为低转运组、低平均转运组、高平均转运组、高转运组,将每组所占比例与其他腹膜透析中心的分组结果进行比较。结果本研究快速腹膜平衡试验结果构成比与其他腹膜透析中心的结果构成比有显著性差异,低平均转运组和高平均转运组比例较高,高转运组和低转运组比例较低。结论本院腹膜透析中心快速腹膜平衡试验结果构成比显示出与其他腹膜透析中心不同的特点,这种差异可能与本院腹膜透析中心的治疗方式有关,提示腹膜透析治疗方式可能影响腹膜转运功能。     

Effects of seasonal changes on peritoneal dialysis associated peritonitis in peritoneal dialysis patients

Objectives To investigate the effects of seasonal changes on peritoneal dialysis associated peritonitis (PDAP) in patients on peritoneal dialysis (PD), and to provide evidence for clinical prevention and treatment of PDAP. Methods All episodes of PD-related peritonitis during clinic follow-up in maintenance PD patients from Jan 1st, 2007 to Dec 31st, 2015 in Peking University People's Hospital were reviewed. The incidence of peritonitis, laboratory indexes, pathogens and clinical outcomes in different seasons were recorded and analyzed. One-way ANOVA and chi square test were employed to compare the incidence of PDAP and related data in different seasons, and Pearson correlation was used to analyze correlations between PDAP rate and monthly mean temperature and mean humidity. Results During nine years, a total of 119 PD patients occurred 190 times of peritonitis during home PD. The PDAP rate in summer was the highest, 0.21 episodes/year, followed by spring (0.16 episodes/year) and autumn (0.16 episodes/risk year), but there was no significant difference among peritonitis rates in four seasons. There were significant positive correlation between monthly mean temperature, monthly mean humidity and the peritonitis rate (mean temperature: r=0.828, P＜0.01; mean humidity r=0.657, P＜0.05). (2) As for bacteria, in Summer the PDAP rate caused by Staphylococcus aureus and Coagulase negative staphylococcus (CoNS), and Gram-negative bacteria was higher than that in other seasons, but there was no statistical difference. There were significant positive correlation between monthly mean temperature, mean humidity and the rate of CoNS peritonitis (mean temperature: r=0.704, P＜0.05; mean humidity: r=0.607, P＜0.05). (3) There were no statistical difference among results of PD related peritonitis in different seasons about general situation, clinical manifestation, causes of peritonitis and laboratory index before peritonitis episodes. PD procedure-related problems were the main cause of peritonitis in summer and autumn. (4) The cure rate of all peritonitis was 90%. The highest cure rate was in autumn and winter, while the lowest cure rate was in summer, but no statistical difference. Among the peritonitis episodes with treatment failure, 52.6% occurred in summer. Conclusions There is some correlation between the rate of PDAP and seasons. Higher temperature and higher humidity were significantly correlated with higher peritonitis rate, especially the rate of CoNS peritonitis. The prognosis of PDAP in summer was relatively poor, with higher proportion of hospitalization and lower cure rate.     

抑郁障碍对腹膜透析患者的影响

目的：研究腹膜透析（腹透）患者产生抑郁障碍的可能因素及其对腹透的影响,尝试药物治疗,以期改善生活质量,方法：选择无精神病史的规律性腹透患者43例,进行汉密顿抑郁量表（HAMD）和抑郁自评量表（SDS）评分,并分为抑郁组和非抑郁组,在组间进行性别,年龄,文化程度和医疗付费情况的比较,观察患者透析充分性,营养,感染率,主不业率及顺应性在组织间的差异,并选择重度抑郁状态者预以抗抑郁治疗（Prozac20mg/d),观察疗效,结果：（1）37．2％的患者存在抑郁障碍,（2）通过比较,两组的年龄,性别,文化,程度,婚烟障碍和医疗付费情况均无显著差异,（3）两组间的顺应性差异有显著性意义（不顺应者在抑郁组中占53．3％,非抑郁组仅7．7％,P＜0．01）,感染率差异也有显著性意义（抑郁组：0．04）,SAG评分示抑郁组营养不良占62％,非抑郁组占4．3％,（P＜0．05）,（4）在16例中选6例预Prozac治疗1月后重测HAMD和SDS评分,相关因子分下降（例少未统计）,结论：抑郁状态在腹透患者中常见,它可造成腹透患者的营养不良,顺应性下降,透析不充分,感染率上升,抗抑郁的药物治疗可望改善患者的抑郁状态。     

改良腹膜平衡试验在腹膜透析患者中的应用

目的 观察改良腹膜平衡试验(改良PET)在腹膜透析(腹透)患者中的应用,初 步建立改良PET转运参数的参考值,探讨其评估腹膜溶质转运特性的准确性及临床意义。方法 97例腹透患者用高渗腹透液(4．25％葡萄糖)进行改良PET,分别测定4 h透析液肌酐与血肌酐 比值(4h D／Pcr)、计算物质转运面积系数(MTAC)、1 h透析液钠与血钠比值(1h D／PNa+)及记录 净超率量(nUF)。其中有14例患者在1个月内曾行标准腹膜平衡试验(标准PET),其结果与改 良PET进行自身比较。所有患者在研究时及研究前1个月内均无腹膜炎。结果 97例腹透患 者中有90例nUF大于400 ml,这些患者的转运参数经正态分布校正后建立了改良PET的参考 值。改良PET的4 hD／Pcr为0．70±0．15,标准PET4 hD／Pcr为0．68±0．13,两者非常接近,差异 无统计学意义。两种PET对患者腹膜转运特性分型结果相似。7例nUF小于400 ml的患者中有 5例有效腹膜表面积增大;2例存在水通道介导的水转运障碍,其中1例同时存在有效腹膜表面 积增大,还有1例患者改良PET转运参数在正常范围内。结论 与标准PET相比,用高渗腹透 液进行改良PET能够准确地评估腹膜小分子溶质转运特性,此外还能提供更多更敏感的液体转 运信息,为临床诊断超滤衰竭,以及进一步鉴别其原因提供了有力的手段。     

Hyperkalemia in chronic peritoneal dialysis patients

Background. Chronic peritoneal dialysis (PD) patients often develop hypokalemia but less commonly hyperkalemia.Methods. We explored incidence and mechanisms of hyperkalemia in 779 serum samples from 33 patients on PD for 1 − 59 months. Normal serum potassium concentration was defined as 3.5 − 5.1 meq/l.Results. Mean monthly serum potassium concentrations were normal (except for 1 month), but we observed hypokalemia (<3.5 meq/l) in 5% and hyperkalemia (>5.1 meq/l) in 14% of 779 serum samples. Incidence of hyperkalemia did not change over time on PD: Year 1 (15%), Year 2 (11%), Year 3 (19%), Years 4–5 (22%). Hyperkalemia was mostly modest but occasionally extreme [5.2–5.4 meq/l (55%), 5.5–5.7 meq/l (21%), 5.8–6.0 meq/l (10%), >6.0 meq/l (14%)]. Of 31 patients (2 excluded due to brief PD time), 39% displayed hyperkalemia only, 23% displayed hypokalemia only, and the remainder (38%) displayed both or neither. Comparing hypokalemia-only with hyperkalemia-only patients, we found no difference in potassium chloride therapy, medications interrupting the renin-angiotensin system, small-molecule transport status, and renal urea clearance. We compared biochemical parameters from the hypokalemic and hyperkalemic serum samples and observed lower bicarbonate concentrations, higher creatinine concentrations, and higher urea nitrogen concentrations in the hyperkalemic samples (p < 0.001 for each), without difference in glucose concentrations.Conclusion. We observed hyperkalemia 3 times as frequently as hypokalemia in our PD population. High-potassium diet, PD noncompliance, increased muscle mass, potassium shifts, and/or the daytime period without PD might contribute to hyperkalemia.