摘要
目的探讨长透析龄腹膜透析慢性肾脏病(CKD)患者的临床特点、腹膜功能变化,以及标准化蛋白分解率(nPCR)诊断该类患者透析充分性的效能。方法选择2009至2022年在东莞东华医院行维持性不卧床腹膜透析(CAPD)的CKD患者,分为长透析龄组和短透析龄组,长透析龄组根据腹膜平衡试验中D/Pcr的平均值分为高腹膜平衡试验(PET)组和低PET组,比较各组间差异。应用Friedman检验分析溶质转运的变化趋势,Spearman检验和受试者操作特征(ROC)曲线分别评估nPCR与透析充分性的相关性和诊断效能。结果长透析龄人群中,高PET组血白蛋白、nPCR较低,肌酐清除指数(Ccr)较高,透析前5年的D/Pcr呈先下降后回升的趋势。nPCR与Ccr、尿素清除指数(Kt/V)呈正相关(rs分别为0.305,0.288,均P<0.05),与D/Pcr呈负相关(rs=-0.417,P<0.001),且nPCR诊断透析充分性的ROC曲线下面积为0.68(均P<0.05)。结论在长透析龄CKD患者中,腹膜功能呈先下降后升高的趋势,nPCR可作为营养指标用于评估透析的充分性。
Objective To investigate the clinical characteristics and peritoneal function changes in chronic kidney disease(CKD)patients undergoing long-term peritoneal dialysis(PD),and to evaluate the diagnostic utility of normalized protein catabolic rate(nPCR)in assessing dialysis adequacy in this population.Methods CKD patients receiving continuous ambulatory peritoneal dialysis(CAPD)at Dongguan Tungwah Hospital from 2009 to 2022 were selected,and divided into long-term and short-term dialysis groups.The long-term dialysis group was further categorized into high and low peritoneal equilibration test(PET)subgroups according to the average D/Pcr from PET.Intergroup differences were compared.The trend of solute transport was analyzed using the Friedman’s test,while Spearman’s correlation and receiver operating characteristic(ROC)curve analysis were employed to assess the correlation between nPCR and dialysis adequacy,and the diagnostic performance of nPCR,respectively.Results Among long-term dialysis patients,those in the high PET subgroup exhibited lower levels of serum albumin and nPCR,but higher creatinine clearance index(Ccr)(all P<0.05).The D/Pcr showed a downward trend followed by an upward trend over the first five years of dialysis(all P<0.05).nPCR was positively correlated with Ccr(rs=0.305,P<0.05)and urea clearance index(Kt/V,rs=0.288,P<0.05),and negatively correlated with D/Pcr(rs=-0.417,P<0.001).The area under the ROC curve for nPCR in diagnosing dialysis adequacy was 0.68(P<0.05).Conclusion In CKD patients with long-term peritoneal dialysis,peritoneal function tends to decline initially and then improve.nPCR can serve as a nutritional indicator for evaluating dialysis adequacy.
作者
王洋洋
胡洁萍
郑玮
唐杏明
WANG Yangyang;HU Jieping;ZHENG Wei;TANG Xingming(Department of Nephrology,Rheumatism and Immunology,Dongguan Tungwah Hospital,Dongguan 523000,China;Guangdong Medical University,Zhanjiang 524000,China)
出处
《新医学》
2025年第9期889-895,共7页
Journal of New Medicine
关键词
腹膜透析
腹膜功能
标准化蛋白分解率
透析充分性
透析龄
Peritoneal dialysis
Peritoneal function
Normalized protein catabolic rate
Dialysis adequacy
Dialysis duration
