腹膜透析患者脂质代谢紊乱与腹膜转运功能及生存的关系

摘要

Objective To observe the features of lipid metabolism disorders of peritoneal dialysis (PD) patients and hemodialysis (HD) patients and explore the association of lipid metabolism disorder with peritoneal transport function and mortality.Methods The clinical data of 127 PD patients and 95 HD patients who had received regular dialysis for more than 3 months in Peking Union Medical College Hospital since March 2009 were retrospectively analyzed.Serum lipid profiles were tested.Serum hypersensitive C reactive protein (hsCRP) was examined by immune turbidimetric method.Serum carbohydrate antigen 125 (CA125) and intact parathyroid hormone (iPTH) were detected by electrochemical luminescence method.Peritoneal transport function was evaluated through peritoneal equilibration test (PET).After a 2-year follow-up,the levels of CA125and the peritoneal transport function were compared between the baseline data and the end point,and the relationship between lipid disorder and the mortality was analyzed.Results After the 2-year follow-up,25(19.7％) PD patients died.The leading cause of death was congestive heart failure (56.0％),followed by myocardial infarction (12.0％),septic shock (12.0％),respiratory failure (8.0％),asphyxiation (8.0％),and gastrointestinal bleeding (4.0％).Compared with the survivors,the death patients were older (P =0.005),with significant lower albumin level (P =0.000) and pre-albumin level (P =0.001).However,there was no significant difference in other clinical features including body mass index,blood pressure,dialysis time,nPCR,iPTH,hemoglobin,hsCRP,and serum lipid level (all P ＞ 0.05).COX regression analysis showed that diabetes mellitus (P =0.030) and low mean systolic blood pressure (SBP) (P =0.048) were significantly associated with the mortality of PD patients.At the baseline,the CA125 level in patients with high,high average,and low average transport status of peritoneum was (38.02 ± 64.37),(21.21 ± 19.41),and (17.55 ± 23.2) U/ml,respectively (P =0.09).There was no association between the transport status and lipid (TC,TG and LDL).Conclusions Congestive heart failure is the leading cause of death among PD patients.Diabetes and low mean SBP are the dependent risk factors of mortality.Lipid disorder is associated with CA125,while its association with peritoneal transport function or mortality was not found.%目的 比较腹膜透析(PD)与血液透析(HD)患者脂质代谢紊乱的特点,观察其与腹膜转运状态及生存的关系.方法 选择2009年3月在北京协和医院规律透析3个月以上PD患者127例及维持性HD患者95例,收集并记录所有患者临床资料,检测血脂全套,免疫透射比浊法检测血清高敏C反应蛋白(hsCRP),电化学发光法检测血糖链抗原CA125和全段甲状旁腺激素(iPTH),腹膜平衡实验观察腹膜转运功能.随访2年,比较人组时和终止时CA125及腹膜转运功能变化,观察脂代谢紊乱与患者远期结局的关系.结果 随访2年时,127例PD患者中,25例(19.7％)死亡,主要死亡原因为充血性心力衰竭(56.0％)、心肌梗死(12.0％)、感染性休克(12.0％)、呼吸衰竭(8.0％)、窒息(8.0％)和消化道出血(4.0％).与生存组患者相比,死亡组患者的年龄更大(P =0.005),白蛋白(P=0.000)和前白蛋白(P=0.001)更低；两组在体重指数、血压、透析时间、iPTH、血红蛋白、hsCRP和血脂方面差异均没有统计学意义(P均＞0.05).COX回归分析结果显示,糖尿病(P=0.030)和平均收缩压低(P =0.048)是PD患者死亡的相关危险因素.研究结束时,CA125水平较开始时略降低,并没有统计学意义,且下降幅度和比例与LDL无关.高转运、高平均转运和低平均转运组患者的CA125水平分别为(38.02±64.37)、(21.21±19.41)和(17.55±23.2) U/ml,差异无统计学意义(P=0.09).各不同转运模式与TC、TG和LDL无明显相关性.结论 PD患者主要死亡原因是充血性心力衰竭.糖尿病和平均收缩压低是PD患者死亡的相关危险因素.脂代谢与反映腹膜功能的CA125相关,但没有观察到其与腹膜转运状态和死亡的相关性.