CAJ | 학술논문

目的探讨免疫法粪便隐血试验(IFOBT)在慢性肾脏病患者发生结直肠病变的预测意义及作为慢性肾脏病患者预后指标的临床价值.方法前瞻性纳入176例慢性肾脏病(CKD)患者和180例健康人作为对照.使用免疫法粪便隐血试验进行检测,比较两组粪便隐血阳性发生率.同时对CKD患者随访4.5年,分析各项临床、生化指标,并以患者接受肾脏替代治疗或死亡为终点事件.采用Logistic回归进行危险因素分析,采用Kaplan-Meier分析和COX回归模型进行生存分析.结果 176例CKD患者IFOBT阳性率17％,高于健康对照组5.3％(x2=13.236,P＜ 0.01).与IFOBT阴性的CKD患者相比,IFOBT阳性的CKD患者年龄较大[(62.030±15.544)岁比(48.660±19.018)岁,P＜0.01]、红细胞沉降率明显升高[(71.800±31.657) mm/h比(57.210±32.712) mm/h,P＜0.05]、C反应蛋白明显升高[6.230 (3.000～14.148) mg/L比3.000(3.000 ～6.833)mg/L,P＜0.05]、Scr明显升高[419.100(103.200～546.625) μmol/L比175.100 (68.150～462.950) μmol/L,P＜0.05],而血红蛋白[(97.970±20.590 )g/L比(107.170±27.988)g/L,P＜0.05]及肾小球滤过率(eGFR)[11.400 (8.671～53.544) ml· min-1· (1.73 m2)-1比35.274(10.961～82.145)ml·min-1.(1.73 m2)-1,P＜0.01]显著降低.相关法分析显示CKD患者IFOBT检测值与eGFR(r=-0.20,P＜0.01)呈负相关;与Scr呈正相关(r=0.171,P＜0.05);与年龄呈正相关(r=0.175,P＜0.05).Logistic回归和COX回归分析结果显示IFOBT检测值、eGFR和红细胞沉降率是CKD患者预后的重要影响因素.Kaplan-Meier分析显示IFOBT检测值＞100 μg/L是影响CKD患者生存率的重要因素.结论慢性肾脏病患者易发生结直肠出血性疾病,粪便隐血阳性是影响CKD患者预后的重要危险因素,而免疫法粪便隐血试验是可行有效的检测方法,对于CKD患者结直肠病变的预测具有重要的临床意义.
목적 탐토면역법분편은혈시험(IFOBT)재만성신장병환자발생결직장병변적예측의의급작위만성신장병환자예후지표적림상개치.방법 전첨성납입176례만성신장병(CKD)환자화180례건강인작위대조.사용면역법분편은혈시험진행검측,비교량조분편은혈양성발생솔.동시대CKD환자수방4.5년,분석각항림상、생화지표,병이환자접수신장체대치료혹사망위종점사건.채용Logistic회귀진행위험인소분석,채용Kaplan-Meier분석화COX회귀모형진행생존분석.결과 176례CKD환자IFOBT양성솔17％,고우건강대조조5.3％(x2=13.236,P＜ 0.01).여IFOBT음성적CKD환자상비,IFOBT양성적CKD환자년령교대[(62.030±15.544)세비(48.660±19.018)세,P＜0.01]、홍세포침강솔명현승고[(71.800±31.657) mm/h비(57.210±32.712) mm/h,P＜0.05]、C반응단백명현승고[6.230 (3.000～14.148) mg/L비3.000(3.000 ～6.833)mg/L,P＜0.05]、Scr명현승고[419.100(103.200～546.625) μmol/L비175.100 (68.150～462.950) μmol/L,P＜0.05],이혈홍단백[(97.970±20.590 )g/L비(107.170±27.988)g/L,P＜0.05]급신소구려과솔(eGFR)[11.400 (8.671～53.544) ml· min-1· (1.73 m2)-1비35.274(10.961～82.145)ml·min-1.(1.73 m2)-1,P＜0.01]현저강저.상관법분석현시CKD환자IFOBT검측치여eGFR(r=-0.20,P＜0.01)정부상관;여Scr정정상관(r=0.171,P＜0.05);여년령정정상관(r=0.175,P＜0.05).Logistic회귀화COX회귀분석결과현시IFOBT검측치、eGFR화홍세포침강솔시CKD환자예후적중요영향인소.Kaplan-Meier분석현시IFOBT검측치＞100 μg/L시영향CKD환자생존솔적중요인소.결론 만성신장병환자역발생결직장출혈성질병,분편은혈양성시영향CKD환자예후적중요위험인소,이면역법분편은혈시험시가행유효적검측방법,대우CKD환자결직장병변적예측구유중요적림상의의.
Objective To evaluate the value of immunofecal occult blood test (IFOBT) as a prognostic indicator in CKD patients with colorectal impairment.Methods A total of 176CKD patients and 180 healthy adults as control were enrolled.Serum biochemistry was measured at baseline and gastrointestinal bleeding was determined by IFOBT.All the CKD patients were followed up for 4.5 years.Renal replacement therapy or death was defined as end-point event.The Logistic regression analysis was used for risk factors.Kaplan-Meier analysis and COX regression model were used for survival analysis.Results The positive rate of IFOBT in CKD patients was significantly higher than healthy control (17％ vs 5.3％,χ2=13.236,P＜0.01).When comparing with IFOBT negitive patients,IFOBT positive patients were older [(62.030±15.544) years old vs (48.660±19.018)years old,P＜0.01],had higher ESR [(71.800±31.657) mu/h vs (57.210±32.712) mm/h,P＜0.05],C-reactive protein [6.230 (3.000～14.148) mg/L vs 3.000 (3.000～6.833)mg/L,P＜0.05],serum creatinine [419.100 (103.200～546.625) μmol/L vs 175.100 (68.150～462.950) μmol/L,P＜0.05],and had lower hemoglobin level [(97.970±20.590) g/L vs (107.170±27.988) g/L,P＜0.05] and eGFR [11.400 (8.671～53.544) ml·min1·(1.73 m2)1 vs 35.274(10.961～82.145) ml·min-1·(1.73 m2)-1,P＜0.01].There was a negative correlation between IFOBT value and eGFR in CKD patients (r=-0.20,P＜0.01).Positive correlations of IFOBT value with age (r=0.175,P＜0.05) and serum creatinine (r=0.171,P＜0.05) were found.Logistic regression and COX regression analysis showed that IFOBT value,eGFR and ESR were important factors that influenced the prognosis of CKD patients.Kaplan-Meier analysis revealed that IFOBT value ＞100μg/L predicted progression of renal function.Conclusions The prevalence of gastrointestinal bleeding disorder is high in patients with CKD.Value of IFOBT independently predicts decline in renal function of CKD patients.