摘要
目的:分析腹膜透析(PD)患者血清肌酐(SCr)与胱抑素C(CysC)比值(SCr/CysC)与体成分、心血管塑型及预后的关系。方法:纳入2019年5月至9月于国家肾脏疾病临床医学研究中心随访且PD时间≥1年患者104例。晨起空腹排空透析液后抽取静脉血,检测血液常规与生化,生物电阻抗测量人体成分。经胸心脏超声测量左心室舒张末期内径(LVEDd)、后壁厚度(PWT)、室间隔厚度(IVST)。计算相对室壁厚度(RWT)、左心室质量(LVM)和左心室质量指数(LVMI)。螺旋CT检测并计算冠脉钙化评分(CACS)。腹部侧位X线片计算腹主动脉钙化Kauppila积分(AACS)。计算SCr/CysC,并与体成分、心血管塑型之间进行相关性分析。纳入对象继续随访2年,以发生复合事件(死亡或技术失败或再住院)行多因素Logistic回归分析。结果:104例PD患者年龄46.7±12.2岁,其中男性51例(49%),日间不卧床腹膜透析(DAPD)87例,持续不卧床腹膜透析(CAPD)17例,透析龄49.3±25.2月,总尿素清除指数(Kt/V)1.85±0.71,SCr/CysC比值0.86±0.23。单因素相关性分析显示SCr/CysC与体质量指数(BMI)、上臂肌围、骨骼肌质量指数(SMI)、细胞内液/总体液比值(ICW/TBW)、残肾功能(rGFR)、标准化蛋白质分解率(nPCR)、校正总体肌酐清除率(Ccr)、LVM呈显著正相关,与主观综合营养评估(SGA)、细胞外液/总体液比值(ECW/TBW)呈显著负相关(P均<0.05),但与LVMI、临床意义钙化相关性无统计学意义。继续随访2年,发生复合事件43例(41.3%),多元Logistic回归分析显示,上臂肌围(OR=0.969,95%CI 0.944~0.995)、LVMI(OR=1.067,95%CI 1.035~1.100)和SCr/CysC(OR=0.116,95%CI 0.031~0.432)是发生复合事件独立相关因素。结论:PD患者SCr/CysC与体成分参数存在显著相关性,SCr/CysC降低是PD患者不良预后独立危险因素。
Objective:To evaluate the feasibility of serum creatinine/cystatin C(SCr/CysC)ratio in the assessment of clinical events in peritoneal dialysis(PD)patients.Methodology:This was a cross-sectional study.Patients aged 16~65 years with maintained PD treatment were enrolled in this study.Baseline clinical characteristics such as gender,age,smoking,diabetes,blood pressure,body surface area(BSA),body mass index(BMI)were obtained.Serum Cr,CysC were measured by standard laboratory techniques.Body composition was examined with BIA.All patients were examined by transthoracic echocardiography to measure diameter of left ventricle.Left ventriclar mass index(LVMI)and relative wall thickness(RWT)were obtained by calculation.The relations between SCr/CysC ratio with body composition,left ventricular geometry remodeling and clinical events(mortality,technique failure,or re-hospitalization)were evaluated by Logistic regression.Results:A total of 104 PD patients were enrolled in final analysis.The mean age of participants was 46.7 years.Among them,51(49%)were males.PD treatment modality was mainly DAPD,and mean PD vintage was 49.3 months.Dialysis adequacy data shown with total(renal+peritoneal)Kt/V was 1.85±0.71.Mean SCr/CysC ratio was 0.86±0.23.Variables with moderate to strong correlations with SCr/CysC ratio were body mass index(BMI),arm muscle circumference(AMC),lean body mass(LBM),intracellular water to total body water ratio(ICW/TBW),residual renal function(rGFR),normalized protein catabolic rate(nPCR),creatinine clearance rate(Ccr),left ventricular mass(LVM),subjective global nutritional assessment(SGA),extracellular water to total body water ratio(ECW/TBW).Logistic regression analyses showed that AMC(OR=0.969,95%CI 0.944~0.995),SCr/CysC(OR=0.116,95%CI 0.031~0.432)ratio,and LVMI(OR=1.067,95%CI 1.035~1.100)was independently factor related with clinical events during two years.Conclusion:The SCr/CysC ratio is appropriate for evaluating body composition and is associated with the clinical events in PD patients with maintained PD treatment.
作者
张志宏
娄丽璇
余乐
成水芹
周婷婷
俞雨生
ZHANG Zhihong;LOU Lixuan;YU Le;CHEN Shuiqin;ZHOU Tingting;YU Yusheng(National Clinical Research Center for Kidney Diseases,Jinling Hospital,Nanjing 210016,China)
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2023年第5期431-436,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
东部战区总医院临床诊疗新技术项目(22LCZLXJS25)。
关键词
腹膜透析
体成分
血清肌酐/胱抑素C比值
peritoneal dialysis
body composition
serum creatinine/cystatin C ratio
