CAJ | 학술논문

目的研究腹膜透析(PD)患者的体质量指数(BMI)与预后的相关关系.方法回顾性分析2008年1月始在本院接受CAPD治疗的81例患者临床资料,按BMI分为低体质量组(BMI＜ 18.5 kg/m2);正常体质量组(18.5 ～ 23.9 kg/m2);超体质量组(24 ～ 27.9 kg/m2)和肥胖组(BMI≥28 kg/m2).连续观察36个月,截止时间2013年12月.采用Kaplan-Meier法比较81例患者的生存率和技术生存率,Cox比例风险模型分析BMI与预后的关系.结果与正常体质量组相比,低体质量组和肥胖组患者的累积生存率显著下降(均P＜ 0.01);超体质量组累积生存率差异无统计学意义;肥胖组患者的技术生存率显著降低(P＜0.01);超体质量组和低体质量组技术生存率差异无统计学意义.腹膜透析技术失败的主要原因为腹膜炎(81.3％).CAPD患者的BMI与白蛋白(r=0.24,P＜0.05)、血红蛋白(r=0.56,P＜0.01)、血糖(r=0.23,P＜0.05)、胆固醇(r=0.41,P＜ 0.01)呈正相关,与总Kt/V(r=-0.36,P＜ 0.01)、Ccr(r=-0.34,P＜ 0.01)呈负相关.经校正后的Cox比例风险模型结果提示,与正常体质量组相比,肥胖组PD患者的死亡风险明显增加(HR:5.93,95％CI:1.10 ～ 31.79).肥胖(HR:10.33,95％CI:1.04 ～ 78.02)和腹膜炎(HR:2.74,95％CI:1.17 ～ 6.40)是腹膜透析技术失败的独立危险因素.结论低体质量和肥胖的CAPD患者生存率较低,肥胖的CAPD患者技术生存率最低;肥胖可能是影响CAPD患者生存的独立危险因素.
목적 연구복막투석(PD)환자적체질량지수(BMI)여예후적상관관계.방법 회고성분석2008년1월시재본원접수CAPD치료적81례환자림상자료,안BMI분위저체질량조(BMI＜ 18.5 kg/m2);정상체질량조(18.5 ～ 23.9 kg/m2);초체질량조(24 ～ 27.9 kg/m2)화비반조(BMI≥28 kg/m2).련속관찰36개월,절지시간2013년12월.채용Kaplan-Meier법비교81례환자적생존솔화기술생존솔,Cox비례풍험모형분석BMI여예후적관계.결과 여정상체질량조상비,저체질량조화비반조환자적루적생존솔현저하강(균P＜ 0.01);초체질량조루적생존솔차이무통계학의의;비반조환자적기술생존솔현저강저(P＜0.01);초체질량조화저체질량조기술생존솔차이무통계학의의.복막투석기술실패적주요원인위복막염(81.3％).CAPD환자적BMI여백단백(r=0.24,P＜0.05)、혈홍단백(r=0.56,P＜0.01)、혈당(r=0.23,P＜0.05)、담고순(r=0.41,P＜ 0.01)정정상관,여총Kt/V(r=-0.36,P＜ 0.01)、Ccr(r=-0.34,P＜ 0.01)정부상관.경교정후적Cox비례풍험모형결과제시,여정상체질량조상비,비반조PD환자적사망풍험명현증가(HR:5.93,95％CI:1.10 ～ 31.79).비반(HR:10.33,95％CI:1.04 ～ 78.02)화복막염(HR:2.74,95％CI:1.17 ～ 6.40)시복막투석기술실패적독립위험인소.결론 저체질량화비반적CAPD환자생존솔교저,비반적CAPD환자기술생존솔최저;비반가능시영향CAPD환자생존적독립위험인소.
Objective To evaluate the association between body-mass index and prognosis in peritoneal dialysis (PD) patients.Methods In this observational study of a single nephrology unit in Shanghai East Hospital,81 incident continuous ambulatory peritoneal dialysis(CAPD) patients were included from Jan 2008 to Dec 2013,whom were followed-up by 36 months or until death.The patients were classified as underweight (BMI ＜ 18.5 kg/m2); normal weight (18.5 ～ 23.9 kg/m2); overweight (24 ～ 27.9 kg/m2) and obese (BMI≥28 kg/m2).The patients and technique survival rates were estimated by Kaplan-Meier analysis.Cox proportional hazards analyses were used to elucidate relationship between BMI and all-cause mortality and technique failure in PD patients.Results The overall survival rate was similar between normal and overweight groups (P=0.96),but significantly lower in underweight group and obese group (P ＜ 0.01 respectively).The overall technical survival rate of obese group was lower compare with normal group (P ＜ 0.01).The main cause of technical failure was peritonitis (81.3％).BMI was positively correlated with albumin (r=0.24,P ＜ 0.05),hemoglobin (r=0.56,P ＜ 0.01),glucose(r=0.23,P＜0.05) and cholesterol (r=0.41,P＜0.01),but negatively correlated with Kt/V (r=-0.36,P ＜ 0.01) and Ccr(r=-0.34,P ＜ 0.01).In adjusted Cox proportional hazard mode 3,obese was independently associated with all-cause mortality (HR:5.93,95％ CI:1.10～31.79).Obese and peritonitis were independently associated with technical failure (HR:10.33,95％CI:1.04～ 78.02 and HR:2.74,95％ CI:1.17 ～ 6.40 respectively).Conclusions Underweight and obese CAPD patients have poorer outcome.Obese CAPD patients also have lower technical survival rate.Obesity was an independent risk factor for all-cause mortality in CAPD patients.