CAJ | 학술논문

目的探讨合并糖尿病的非糖尿病肾病腹膜透析(腹透)患者的长期预后.方法回顾性分析1995年1月1日至2012年6月30日期间在上海交通大学医学院附属仁济医院腹透中心接受腹透的糖尿病终末期肾病(ESRD)患者的临床资料.按照原发病分为糖尿病肾病组(DKD)组;合并糖尿病的非糖尿病肾病(NDKD)组.随访终点事件为患者死亡、退出腹透和转出中心,随访终点时间为2013年6月30日.采用Kaplan-Meier法计算患者生存率、技术生存率和无腹膜炎生存时间;Cox比例风险模型分析影响患者预后的危险因素.结果 163例糖尿病ESRD患者入选本研究.与DKD组相比,NDKD组患者的空腹血糖水平较低,血清C反应蛋白(CRP)水平较高;标准化蛋白代谢率较高;腹膜透析剂量、透析液葡萄糖暴露量以及腹膜肌酐清除率均较低(均P＜ 0.05).Kaplan-Meier分析结果显示,NDKD组患者生存率低于DKD组(P=0.028).与DKD组相比,NDKD组患者有较早发生首次腹膜炎的趋势(P=0.061),但两组患者技术生存率的差异无统计学意义.多因素Cox比例风险模型分析显示,高龄(HR 1.047,95％ CI为1.022～ 1.073,P＜0.001),心血管合并症(HR 2.200,95％ CI为0.1.269～3.814,P=0.005)及合并糖尿病的非糖尿病肾病(HR 1.806,95％ CI 1.003～ 3.158,P=0.038)是影响糖尿病腹透患者死亡的独立危险因素.血清C反应蛋白(HR 1.023,95％ CI为1.008-1.036,P=0.003)是糖尿病腹透患者较早发生首次腹膜炎的独立危险因素.结论与糖尿病肾病患者相比,合并糖尿病的非糖尿病肾病腹透患者死亡率更高,预后更差,提示该人群需要更密切的临床监测及关注.
목적 탐토합병당뇨병적비당뇨병신병복막투석(복투)환자적장기예후.방법 회고성분석1995년1월1일지2012년6월30일기간재상해교통대학의학원부속인제의원복투중심접수복투적당뇨병종말기신병(ESRD)환자적림상자료.안조원발병분위당뇨병신병조(DKD)조;합병당뇨병적비당뇨병신병(NDKD)조.수방종점사건위환자사망、퇴출복투화전출중심,수방종점시간위2013년6월30일.채용Kaplan-Meier법계산환자생존솔、기술생존솔화무복막염생존시간;Cox비례풍험모형분석영향환자예후적위험인소.결과 163례당뇨병ESRD환자입선본연구.여DKD조상비,NDKD조환자적공복혈당수평교저,혈청C반응단백(CRP)수평교고;표준화단백대사솔교고;복막투석제량、투석액포도당폭로량이급복막기항청제솔균교저(균P＜ 0.05).Kaplan-Meier분석결과현시,NDKD조환자생존솔저우DKD조(P=0.028).여DKD조상비,NDKD조환자유교조발생수차복막염적추세(P=0.061),단량조환자기술생존솔적차이무통계학의의.다인소Cox비례풍험모형분석현시,고령(HR 1.047,95％ CI위1.022～ 1.073,P＜0.001),심혈관합병증(HR 2.200,95％ CI위0.1.269～3.814,P=0.005)급합병당뇨병적비당뇨병신병(HR 1.806,95％ CI 1.003～ 3.158,P=0.038)시영향당뇨병복투환자사망적독립위험인소.혈청C반응단백(HR 1.023,95％ CI위1.008-1.036,P=0.003)시당뇨병복투환자교조발생수차복막염적독립위험인소.결론 여당뇨병신병환자상비,합병당뇨병적비당뇨병신병복투환자사망솔경고,예후경차,제시해인군수요경밀절적림상감측급관주.
Objective To investigate the long-term outcomes of peritoneal dialysis (PD) patients with diabetes as a comorbid condition.Methods All diabetic patients who commenced PD between January 1,1995 and June 30,2012 at Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine were included in the present study.Patients were divided into diabetic kidney disease group (DKD group) and non-diabetic kidney disease group (NDKD group) according to their diagnosis of primary renal disease at the initiation of PD.They were followed until death,cessation of PD,transferred to other centers or to the end of study (June 30,2013).Outcomes were analyzed by KaplanMeier method.Cox proportional hazards models were utilized to determine the predictors of outcomes.Results A total of 163 diabetic patients were enrolled in the study.Compared with patients in DKD group,patients in NDKD group had a significantly lower fasting plasma glucose,a higher serum Creactive protein level,a higher normalized protein nitrogen appearance,a lower dialysate glucose exposure,a lower peritoneal creatinine clearance and were treated with lower dialysate dose (all P ＜ 0.05).Kaplan-Meier analysis showed that patients in NDKD group had a worse patient survive compared to those in DKD group (log rank Chi-square=4.830,P=0.028).Patients in NDKD group had a marginally shorter peritonitis-free period (log rank Chi-square=3.297,P=0.069),however,there was no significant difference in technique survival between these two groups.Multivariate Cox regression analysis showed that older age (HR 1.047,95％CI 1.022～1.073,P ＜ 0.001) and cardiovascular disease comorbidity (HR 2.200,95％CI 0.1.269～3.814,P=0.005) and diabetes as a comorbid condition (HR 1.806,95％CI 1.003～3.158,P=0.038) were the independent predictors for increased mortality.While higher serum C-reactive protein level (HR 1.023,95％ CI 1.008～1.036,P=0.003) was the independent predictor for shorter peritonitis-free period.Conclusion PD patients with diabetes as a comorbid condition had a higher mortality compared to those with diabetic kidney disease,and closer monitoring and extra attention in the former subgroup of patients are therefore warranted.