代谢综合征与腹膜透析患者预后的相关性研究

目的探究持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者代谢综合征(metabolic syndrome,MS)的发生状况,并分析MS与患者预后的相关性。方法回顾性分析2002年6月1日至2018年4月30日在郑州大学第一附属医院行腹膜透析治疗并规律随访的患者,根据MS诊断标准,将患者分为MS组与非MS组,随访至2018年7月31日。比较两组患者的临床资料、代谢指标及临床结局差异,以Kaplan-Meier生存曲线比较两组患者的生存率;以Cox回归分析分析患者全因死亡及心血管疾病(CVD)死亡的危险因素。结果本研究共纳入516例CAPD患者,年龄(47.29±12.20)岁,其中男性340例(65.9%),女性176例(34.1%),随访时间中位数为20(9,39)个月。依据MS诊断标准,患者被分为MS组(210例,40.7%)和非MS组(306例,59.3%);在临床治疗基线时,两组在年龄、教育背景、腹透龄、吸烟史及饮酒史等方面差异无统计学意义(均P>0.05),而MS组患者更多暴露于高浓度葡萄糖腹透液(P<0.05);在临床化验及代谢指标方面,MS组患者的体重指数、血磷、血糖、血钾、三酰甘油、胆固醇及收缩压水平显著高于非MS组,血高密度脂蛋白水平明显低于非MS组,差异均有统计学意义(均P<0.05),其余各指标两组间差异无统计学意义(均P>0.05)。Kaplan-Meier生存曲线显示,MS组患者累积生存率明显低于非MS组,差异有统计学意义(Log-rank χ^2=14.87,P<0.001);若以CVD死亡作为终点事件,非MS组患者累积生存率明显高于MS组(Log-rank χ^2=14.49,P<0.001)。多因素Cox回归分析校正混杂因素后显示,合并MS、高4h腹透液肌酐/血肌酐比值(4hD/Pcr)是CAPD患者全因死亡(HR=1.982,95%CI1.240~3.168,P=0.004;HR=3.855,95%CI1.306~11.381,P=0.015)及CVD死亡(HR=2.499,95%CI1.444~4.324,P=0.001;HR=5.799,95%CI1.658~20.278,P=0.006)的独立危险因素。结论CAPD患者的MS患病率较高,合并MS、高4hD/Pcr是CAPD患者全因死亡和CVD死亡的独立危险因素,可作为CAPD患者治疗结果及长期预后预测的有价值指标。

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.