CAJ | 학술논문

目的探讨狼疮肾炎(LN)腹膜透析(腹透)患者的长期预后.方法入选1995年5月1日至2013年4月30日期间在本院开始腹透且资料完整的LN患者(n=33),同时入选与其年龄、性别、并发症匹配的非LN腹透患者(n=33)作为对照组.所有入选患者均随访至死亡、退出腹透、转其他中心或至研究终止.采用Kaplan-Meier生存分析和Log-Rank检验比较两组患者的生存率、技术生存率和无腹膜炎生存率.结果腹透开始时,LN组患者的估算肾小球滤过率(eGFR)、抗双链DNA (anti-dsDNA)和高敏C反应蛋白(hs-CRP)水平均明显高于对照组(均P＜ 0.05).截至研究终止,LN组患者有13例(39.4％)死亡,8例(24.2％)转血液透析(血透),5例(15.2％)肾移植,2例(6.1％)转其他中心.LN组患者最常见的死亡原因是感染(9例,69.2％),其中又以腹膜炎最常见(6例,46.2％),而对照组患者最常见的死亡原因是心血管疾病(5例,83.3％).Kaplan-Meier分析显示LN组患者的1、3、5年患者生存率为82％、49％、49％,明显低于对照组(x2=8.455,P=0.004).LN组患者的技术生存率也明显低于对照组(x2=6.753,P=0.009).LN组腹膜炎发生率为1次/20.5病人月,而对照组腹膜炎发生率为1次/67.6病人月.LN组患者的无腹膜炎生存率显著低于对照组(x2=8.256,P=0.004).结论 LN腹膜透析患者的长期预后较差.腹膜炎是LN腹透患者死亡和技术失败的主要原因.
목적 탐토랑창신염(LN)복막투석(복투)환자적장기예후.방법 입선1995년5월1일지2013년4월30일기간재본원개시복투차자료완정적LN환자(n=33),동시입선여기년령、성별、병발증필배적비LN복투환자(n=33)작위대조조.소유입선환자균수방지사망、퇴출복투、전기타중심혹지연구종지.채용Kaplan-Meier생존분석화Log-Rank검험비교량조환자적생존솔、기술생존솔화무복막염생존솔.결과 복투개시시,LN조환자적고산신소구려과솔(eGFR)、항쌍련DNA (anti-dsDNA)화고민C반응단백(hs-CRP)수평균명현고우대조조(균P＜ 0.05).절지연구종지,LN조환자유13례(39.4％)사망,8례(24.2％)전혈액투석(혈투),5례(15.2％)신이식,2례(6.1％)전기타중심.LN조환자최상견적사망원인시감염(9례,69.2％),기중우이복막염최상견(6례,46.2％),이대조조환자최상견적사망원인시심혈관질병(5례,83.3％).Kaplan-Meier분석현시LN조환자적1、3、5년환자생존솔위82％、49％、49％,명현저우대조조(x2=8.455,P=0.004).LN조환자적기술생존솔야명현저우대조조(x2=6.753,P=0.009).LN조복막염발생솔위1차/20.5병인월,이대조조복막염발생솔위1차/67.6병인월.LN조환자적무복막염생존솔현저저우대조조(x2=8.256,P=0.004).결론 LN복막투석환자적장기예후교차.복막염시LN복투환자사망화기술실패적주요원인.
Objective To investigate the long-term outcome of Chinese lupus nephritis (LN) patients undergoing peritoneal dialysis (PD).Methods All LN patients with end-stage renal disease (ESRD) initiating PD between May 1,1995 and Apr 30,2013 at Renji Hospital,Shanghai Jiao Tong University School of Medicine,China,with complete data (n=33) were enrolled.Another 33 age-,gender-and comorbidity-matched non-LN patients receiving PD were selected as the control group for the study.All patients were followed up from the date of PD initiation until death,cessation of PD,transfer to other centers or the end of this study (Dec 31,2013).Kaplan-Meier analysis and Log-Rank test were applied to compare patient survival,technique survival and peritonitis-free survival between two groups.Results Compared to the control group,LN patients had higher eGFR,anti-dsDNA and hs-CRP level at the starting of PD.By the end of the study,in the LN group 13 (39.4％) patients died,8 (24.2％) patients switched to hemodialysis (HD),5(15.2％) patients transplanted and 2(6.1％) patients transferred to other centers.Infection was the most common cause of death in the LN group (9 patients,69.2％),and majority of death was caused by PD-related peritonitis (6 patients,46.2％),while cardiovascular disease (CVD) was the leading cause of death in the control group (5 patients,83.3％).Kaplan-Meier analysis showed that LN patients had significantly lower patient survival (x2=8.455,P=0.004).For both LN group (6 patients,75.0％) and control group (4 patients,66.7％),peritonitis was the leading cause of transfer to HD.Compared to the control group,LN patients had significantly lower technique survival (x2=6.753,P=0.009).Peritonitis rates were 1 episode/20.5 patient-months in the LN group and 1 episode/67.6 patient-months in the control group respectively.LN patients had significantly shorter peritonitis-free survival (x2=8.256,P=0.004) when compared to their counterparts in the control group.Conclusion LN patients with ESRD receiving PD have inferior clinical outcome.Peritonitis is the most common cause of death and technique failure in LN patients.