作　　者： (马莹）; (王海云）; (周紫娟）; (李阳）; (杨薇）; (刘炳岩）; (夏京华）; (李雪梅）; (陈丽萌）;

机构地区： 中国医学科学院北京协和医学院北京协和医院肾内科,北京100730

出　　处： 《中国医学科学院学报》 2017年第4期485-491,共7页

摘　　要： 目的观察成人多囊肾(PKD)终末期肾病(ESRD)患者的临床指标、透析方式和结局,评价PKD导致ESRD患者接受长期腹膜透析治疗的可行性。方法回顾性收集1993年1月至2015年12月北京协和医院确诊PKD的ESRD患者的临床资料,根据透析方式分为腹膜透析(PKD-PD)组、血液透析(PKD-HD)组,从622例腹膜透析患者中以1∶3选择年龄、性别、开始透析时间与PKD-PD组匹配的非PKD腹膜透析患者作为对照(非PKD-PD组)。以死亡为主要终点事件,利用Kaplan-Meier计算生存率,利用Cox回归模型分析影响患者生存的危险因素。结果共47例PKD患者,包括PKD-PD组33例、PKD-HD组14例,纳入非PKD-PD患者42例作为对照。PKD患者平均年龄(53±11)岁,其中女性患者18例(38.3%)。PKD-PD组与PKD-HD组患者开始透析时年龄、性别、合并症、肾脏大小、残肾功能等差异无统计学意义(P均>0.05)。PKD-PD组平均透析时间(36.2±33.1)个月,透析3个月、1年、3年、5年每周尿素清除指数、每周肌酐清除率、残肾功能年下降率与非PKD-PD组相比差异均无统计学意义(P均>0.05)。平均腹膜炎发生率为1次/84.5个月,透析1年、3年、5年生存率分别为85.7%、78.6%、78.6%,与PKD-HD组、非PKD-PD组相比差异均无统计学意义(P均>0.05)。Cox多因素回归分析显示透析方式不是影响PKD患者预后的独立危险因素。结论腹膜透析可以用于部分PKD导致ESRD患者的长期肾脏替代治疗。 Objective To observe the clinical characteristics,dialysis modalities,and outcomes of end stage renal disease（ESRD） patients with polycystic kidney disease（PKD） and to evaluate the feasibility of peritoneal dialysis in these population.Methods The clinical data of ESRD patient whose primary diagnosis was PKD in Peking Union Medical College Hospital were retrospectively collected from January 1993 to December2015.PKD patients were divided into two groups according to dialysis modality,namely peritoneal dialysis group（PKD-PD） group and hemodialysis（PKD-HD） group.In addition,we randomly chose non-PKD patients from622 peritoneal dialysis patients who were matched with PKD-PD patients in age,gender and dialysis time.The primary end point was death.The survival rate was calculated by Kaplan-Meier analysis and the risk factors for suivival were analyzed by Cox regression model.Results Totally 47 PKD patients were enrolled,including 33 patients in PKD-PD group and 14 patients in PKD-HD group,and 42 non-PKD patients as the control group.The average age of PKD patients was（53±11） years,of which 38.3% were women.When compared with PKD-HD group,no significant difference in age,gender,comorbidities,kidney size,and residual glomerular filtration rate were observed in PKD-PD patients at baseline（all P〈0.05）.The average time on dialysis of PKD-PD patients was（36.2±33.1） months.The weekly urea clearance index（Kt/V） and weekly creatinine clearance were similar to non-PKD-PD group at 3 months,1 year,3 years,and 5 years（all P〈0.05）.The peritonitis rate was 1 episode/84.5 months.The survival rates at 1 year,3 years,and 5 years of PKD-PD group were85.7%,78.6%,and 78.6%,which were similar to non-PKD-PD group and PKD-HD group respectively（all P〈0.05）.Multivariate Cox regression analysis showed that neither PKD nor PD independently predicted the mortality.Conclusion PD can be an option for ESRD patients with PKD.

关 键 词： 多囊肾疾病 腹膜透析 血液透析 存活率分析