单中心腹膜透析患者代谢相关疾病现况调查与相关因素分析
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摘要
目的：调查腹膜透析患者肥胖、糖脂代谢及代谢综合征状况；观察含糖腹透液对腹透患者代谢综合征患病率的影响,并探讨代谢综合征的危险因素。
方法：对2009年1月1日至2012年2月23日期间长期(透龄>2年)在浙江大学附属第一医院肾脏病腹膜透析中心接受腹膜透析治疗的77例患者进行回顾性分析。按腹透治疗后0个月、6个月、12个月、18个月以及24个月分成5组进行研究。
结果：1.终末期肾病(ESRD)肥胖患病率为14.86%,随着腹透时间延长,PD患者的肥胖患病率并无显著性差异。2.随着腹透时间延长,PD患者的空腹血糖水平(FPG)呈现显著升高,尤其在透析1年后血糖升高更明显(P<0.05),但高血糖患病率并不无显著增高。3. ESRD的甘油三酯(TG)水平较高,高TG的患病率高达98.68%。接受腹透治疗后TG进一步显著升高(P<0.01)。4.随着透析时间延长,PD患者的高密度脂蛋白-C(HDL-C)水平呈现显著增加(P=0.005),但低HDL-C患病率反而显著下降。(P=0.032)。5.随着透析时间延长,PD患者低密度脂蛋白-C(LDL-C)水平呈现显著增加(P＜0.01).6. ESRD的MS患病率高达59.21%,腹透2年后MS患病率为73.68%,但随着腹膜透析的进展,其患病率无显著差异(P=0.096)。7.腹膜透析患者MS与非MS各指标比较,除空腹血糖存在显著差异(P<0.01),其他指标并无显著差异(P>0.05)。8.使用单因素分析方法,共有6个因素,包括体重指数(BMI)、FPG、LDL-C、HDL-C、血白蛋白以及每日于腹透液中摄入能量与代谢综合征患病率相关。采用多因素logistic回归方法分析获得MS有统计学意义的主要危险因素,即BMI(OR=1.378, P=0.0295%C11.051～1.806)和FPG(OR=8.459, P=0.013,95%CI1.572-45.513), HDL-C (OR=0.004, P=0.002,95%CI0.000-0.131)则是MS的保护因素。
结论：腹膜透析患者肥胖、血糖、血脂代谢异常以及代谢综合征的患病率均较高。ESRD及PD患者是MS的高危人群。透析时间及透析额外能量并不使代谢综合征的患病率显著升高,BMI与FPG是代谢综合征患病率的主要独立危险因素, HDL-C则是保护因素。
Objective:
To investigate obesity,glycolipid metabolism and metabolic syndrome status in peritoneal dialysis patients.
To observe the effects of glucose-based peritoneal dialysis solution on the prevalence of metabolic syndrome in peritoneal dialysis patients.
To identify the risk factors in peritoneal dialysis patients with metabolic syndrome.
Methods:
A retrospective self-controlled study was performed with77peritoneal dialysis patients who had been long-term (PD duration>2years) peritoneal dialysis treated in peritoneal dialysis center of department of kidney disease of First Affiliated Hospital, Zhejiang University School of Medicine during January1,2009to February23,2012. According to time after peritoneal dialysis (0months,6months,12months,18months and24months) divided into5groups to research.
Result:
1. The prevalence rate of obesity was14.86%in ESRD patients. There were no significantly difference on the incidence rate of obesity in PD patients with PD duration.2.The level of FPG was high significantly in PD patients with PD duration especially in a year after dialysis(P<0.05).but there were no significantly high incidence rate of hyperglycemia.3. The level of TG was4.25±1.10mmol/L in ESRD patients. The prevalence rate of high TG was98.68%,and had increased significantly with PD duration(P<0.01).4. The level of high HDL-C was high significantly in PD patients with PD duration (P=0.005). The prevalence rate of low HDL-C decreased significantly with PD duration (P=0.032).5. The level of high LDL-C was high significantly in PD patients with PD duration (P<0.01).6. The prevalence rate of MS was59.21%in ESRD patients. The prevalence rate of MS was73.68%in patients who been treated by PD more than two years.There were no significantly difference on the incidence rate of MS with PD duration (P=0.096).7. There were no significantly difference on all factors,but the level of FPG(P<0.01),between MS group and non-MS one (P>0.05).8.Employed single factor and multiple factor analysis:The prevalence rate of MS was correlated with BMI、FPG、LDL-C、HDL-C、albumin and dialysis additional energy.BMI(OR=1.378, P=0.02,95%CI1.051-1.806) and FPG(OR=8.459, P=0.013,95%CI1.572-45.513) were major risk factors of MS.HDL-C(OR=0.004, P=0.002,95%CI0.000-0.131) was pretective factor of MS.
Conclusion:
The prevalence of obesity,dysglycaemia, dyslipidemia and MS were high in PD patients. ESRD and PD patients were high risk groups of MS. Long PD duration and Dialysis additional energy did not affect the incidence of MS. BMI and FPG were major risk factors of MS.HDL-C was pretective factor of MS.
方法：对2009年1月1日至2012年2月23日期间长期(透龄>2年)在浙江大学附属第一医院肾脏病腹膜透析中心接受腹膜透析治疗的77例患者进行回顾性分析。按腹透治疗后0个月、6个月、12个月、18个月以及24个月分成5组进行研究。
结果：1.终末期肾病(ESRD)肥胖患病率为14.86%,随着腹透时间延长,PD患者的肥胖患病率并无显著性差异。2.随着腹透时间延长,PD患者的空腹血糖水平(FPG)呈现显著升高,尤其在透析1年后血糖升高更明显(P<0.05),但高血糖患病率并不无显著增高。3. ESRD的甘油三酯(TG)水平较高,高TG的患病率高达98.68%。接受腹透治疗后TG进一步显著升高(P<0.01)。4.随着透析时间延长,PD患者的高密度脂蛋白-C(HDL-C)水平呈现显著增加(P=0.005),但低HDL-C患病率反而显著下降。(P=0.032)。5.随着透析时间延长,PD患者低密度脂蛋白-C(LDL-C)水平呈现显著增加(P＜0.01).6. ESRD的MS患病率高达59.21%,腹透2年后MS患病率为73.68%,但随着腹膜透析的进展,其患病率无显著差异(P=0.096)。7.腹膜透析患者MS与非MS各指标比较,除空腹血糖存在显著差异(P<0.01),其他指标并无显著差异(P>0.05)。8.使用单因素分析方法,共有6个因素,包括体重指数(BMI)、FPG、LDL-C、HDL-C、血白蛋白以及每日于腹透液中摄入能量与代谢综合征患病率相关。采用多因素logistic回归方法分析获得MS有统计学意义的主要危险因素,即BMI(OR=1.378, P=0.0295%C11.051～1.806)和FPG(OR=8.459, P=0.013,95%CI1.572-45.513), HDL-C (OR=0.004, P=0.002,95%CI0.000-0.131)则是MS的保护因素。
结论：腹膜透析患者肥胖、血糖、血脂代谢异常以及代谢综合征的患病率均较高。ESRD及PD患者是MS的高危人群。透析时间及透析额外能量并不使代谢综合征的患病率显著升高,BMI与FPG是代谢综合征患病率的主要独立危险因素, HDL-C则是保护因素。
Objective:
To investigate obesity,glycolipid metabolism and metabolic syndrome status in peritoneal dialysis patients.
To observe the effects of glucose-based peritoneal dialysis solution on the prevalence of metabolic syndrome in peritoneal dialysis patients.
To identify the risk factors in peritoneal dialysis patients with metabolic syndrome.
Methods:
A retrospective self-controlled study was performed with77peritoneal dialysis patients who had been long-term (PD duration>2years) peritoneal dialysis treated in peritoneal dialysis center of department of kidney disease of First Affiliated Hospital, Zhejiang University School of Medicine during January1,2009to February23,2012. According to time after peritoneal dialysis (0months,6months,12months,18months and24months) divided into5groups to research.
Result:
1. The prevalence rate of obesity was14.86%in ESRD patients. There were no significantly difference on the incidence rate of obesity in PD patients with PD duration.2.The level of FPG was high significantly in PD patients with PD duration especially in a year after dialysis(P<0.05).but there were no significantly high incidence rate of hyperglycemia.3. The level of TG was4.25±1.10mmol/L in ESRD patients. The prevalence rate of high TG was98.68%,and had increased significantly with PD duration(P<0.01).4. The level of high HDL-C was high significantly in PD patients with PD duration (P=0.005). The prevalence rate of low HDL-C decreased significantly with PD duration (P=0.032).5. The level of high LDL-C was high significantly in PD patients with PD duration (P<0.01).6. The prevalence rate of MS was59.21%in ESRD patients. The prevalence rate of MS was73.68%in patients who been treated by PD more than two years.There were no significantly difference on the incidence rate of MS with PD duration (P=0.096).7. There were no significantly difference on all factors,but the level of FPG(P<0.01),between MS group and non-MS one (P>0.05).8.Employed single factor and multiple factor analysis:The prevalence rate of MS was correlated with BMI、FPG、LDL-C、HDL-C、albumin and dialysis additional energy.BMI(OR=1.378, P=0.02,95%CI1.051-1.806) and FPG(OR=8.459, P=0.013,95%CI1.572-45.513) were major risk factors of MS.HDL-C(OR=0.004, P=0.002,95%CI0.000-0.131) was pretective factor of MS.
Conclusion:
The prevalence of obesity,dysglycaemia, dyslipidemia and MS were high in PD patients. ESRD and PD patients were high risk groups of MS. Long PD duration and Dialysis additional energy did not affect the incidence of MS. BMI and FPG were major risk factors of MS.HDL-C was pretective factor of MS.
引文
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