体成分分析水负荷参数对不同模式透析患者预后影响的研究
Effect of Overhydration Parameters of Body Composition Monitor on the Prognosis of Patients Treated by Different Dialysis Models
背景??维持性血液透析(MHD)和腹膜透析(PD)是当前尿毒症患者主要的治疗方式,如何更好的制定治疗方案解决透析患者水负荷问题一直都是临床研究的重要内容,应用体成分分析(BCM)对不同模式透析患者转归的影响仍有争议。目的 ?BCM中的水负荷(OH)参数与MHD和PD患者预后的关系。方法 ?纳入2017年10月—2022年9月在北京积水潭医院、北京博爱医院、航空总医院、北京市昌平区医院、北京市昌平区中西医结合医院维持性透析的334例患者为研究对象。根据患者采用肾脏替代治疗模式,将患者分为MHD组(n=188)和PD组(n=146)。通过电子病历系统收集患者一般资料,收集BCM相关参数。对纳入研究的患者进行随访,记录透析治疗参数、体质量(BW)、收缩压、舒张压,计算多次随访结果的平均值,随访期间记录终点事件,首要终点事件为全因死亡(ACM),次要终点事件包括心血管事件(CVE)、复合不良事件(CAE)、外科手术或骨折(SOF)。采用Spearman秩相关分析探究终点事件与BCM参数的相关性,多因素逐步Logistic回归分析探究患者发生次要终点事件的影响因素。采用Kaplan-Meier法绘制患者ACM生存曲线,采用Log-rank检验比较两组患者生存曲线的差异。采用多因素Cox回归分析探究患者ACM的影响因素。结果 ?共311例患者完成了随访,中位随访时间29.9(18.0,36.0)个月,其中MHD组176例,PD组135例完成了随访。MHD组透析龄、BW、目标体质量、脂肪含量、脂肪组织指数高于PD组,水负荷低于PD组(P<0.05)。MHD组体质量平均值、目标体质量平均值、收缩压平均值、脂肪组织含量平均值、脂肪组织指数平均值高于PD组,水负荷平均值、水负荷标准差(OHsd)、水负荷最大变化值(OHd)、水负荷最大变化值低于PD组。MHD组CVE、CAE、SOF的发生率分别为16.5%(29/176)、39.2%(69/176)、4.0%(7/176),PD组分别为45.9%(62/135)、83.0%(112/135)、8.2%(11/135)。MHD组CVE、CAE发生率明显低于PD组(χ2=32.009,P<0.001;χ2=60.132,P<0.001)。多因素Logistic回归分析结果显示MHD组细胞外水平均值/细胞内水平均值(OR=57.974,95%CI=1.393~2413.247)为CVE的影响因素,OHd(OR=1.255,95%CI=1.076~1.462)为CAE的影响因素;PD组患者年龄(OR=1.029,95%CI=1.008~1.052)为CVE的影响因素,OHd为CAE的影响因素(OR=1.962,95%CI=1.355~2.842)。两组患者ACM的Kaplan-Meier生存曲线结果示,PD组ACM发生率高于MHD组(χ2=7.145,P=0.008)。多因素Cox回归分析结果显示,年龄是MHD组ACM的影响因素(HR=1.070,95%CI=1.019~1.123),DBPm(HR=0.942,95%CI=0.854~0.992)、OHsd(HR=3.612,95%CI=2.072~6.296)是PD组ACM的影响因素。结论 ?PD组患者首要终点事件、次要终点事件发生率高于MHD患者,且PD患者较MHD患者OH更明显,BCM所得OH值的波动可以预测PD患者的ACM。
Background ?Maintenance hemodialysisMHDand peritoneal dialysisPDare main treatment methods for uremic patients. It remains an important content of clinical research on better developing treatment protocols to address overhydrationOHin dialysis patientsand the effect of applying body composition monitorBCMon the prognosis of dialysis patients treated with different dialysis models is still controversial. Objective??To explore the relationship between OH parameters of BCM and prognosis in patients treated with MHD and PD. Methods??From October 2017 to September 2022334 patients on maintenance dialysis in Beijing Jishuitan HospitalBeijing Boai HospitalAviation General HospitalBeijing Changping District Hospital and Beijing Changping District Hospital of Integrated Traditional Chinese and Western Medicine were included as the study objects and divided into MHD groupn=188and PD groupn=146according to their renal replacement therapy mode. The general data of and BCM related parameters were collected through the electronic medical record system. Patients included in the study were followed updialysis treatment parametersbody weightBWsystolic blood pressure and diastolic blood pressure were recordedand the average of multiple follow-up results were calculated. Endpoint events were recorded during follow-up periodwith the primary endpoint event as all-cause deathACMsecondary endpoint events as cardiovascular eventsCVEcombined adverse eventsCAEsurgery or fractureSOF. Spearman rank correlation analysis was used to explore the correlation between endpoint events and BCM parametersand stepwise multiple Logistic regression analysis was used to explore the influencing factors of secondary endpoint events in patients. The ACM survival curve was plotted by Kaplan-Meier methodand the difference of survival curve between the two groups was compared by Log-rank test. Multivariate Cox regression analysis was used to explore the influencing factors of ACM. Results??A total of 311 patients completed follow-upwith a median follow-up time of 29.918.036.0monthsincluding 176 patients in MHD group and 135 patients in PD group. Dialysis ageBWtarget body weightadipose tissue content and adipose tissue index in MHD group were higher than those in PD groupand OH was lower than that in PD groupP<0.05. The mean values of body masstarget body weightsystolic blood pressureadipose tissue content and adipose tissue index in MHD group were higher than those in PD groupwhile the mean value of OHstandard deviation of OHOHsdmaximum change value of OHOHdand maximum change value of OH in MHD group were lower than those in the PD group. The incidence of CVECAE and SOF was 16.5% 29/17639.2%69/176and 4.0%7/176in the MHD groupand 45.9%62/13583.0%112/135and 8.2%11/135 in PD grouprespectively. The incidence of CVE and CAE in MHD group was significantly lower than PD groupχ2 =32.009P<0.001χ2 =60.132P<0.001. Multivariate Logistic regression analysis showed that the ratio of mean value of extracellular water to mean value of intracellular water in MHD groupOR=57.97495%CI=1.393-2 413.247was the influencing factor of CVEOHdOR=1.25595%CI=1.076-1.462was the influencing factor of CAE. The age of patients in PD groupOR=1.02995%CI=1.008-1.052was the influencing factor of CVEand OHd was the influencing factor of CAEOR=1.96295%CI=1.355-2.842. Kaplan-Meier survival curve of ACM between the two groups showed that the incidence of ACM in PD group was higher than that in MHD groupχ2 =7.145P=0.008. Multivariate Cox regression analysis showed that ageHR=1.07095%CI=1.019-1.123was the influencing factor of ACM in MHD groupDBPmHR=0.94295%CI=0.854-0.992and OHsdHR=3.61295%CI=2.072-6.296were the influencing factors of ACM in PD group. Conclusion??The incidence of primary endpoint event and secondary endpoint events in PD group was higher than that in MHD patientsand OH was more obvious in PD patients than MHD patients. The fluctuation of OH value obtained by BCM could predict ACM in PD patients.
张东亮、赵景新、马迎春、任建伟、吝许亚、王磊
10.12114/j.issn.1007-9572.2023.0309
内科学临床医学基础医学
肾功能不全肾透析维持性血液透析腹膜透析体成分分析不良结局
Renal insufficiencyRenal dialysisMaintenance hemodialysisPeritoneal dialysisBody composition monitordverse outcomes
张东亮,赵景新,马迎春,任建伟,吝许亚,王磊.体成分分析水负荷参数对不同模式透析患者预后影响的研究[EB/OL].(2023-09-27)[2025-08-18].https://chinaxiv.org/abs/202309.00216.点此复制
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