腹透1年时血清白蛋白变化对腹膜透析患者死亡风险的预测价值

金李; 吕晶; 王晓培; 梁嫦娜; 李昭; 路万虹

doi:10.16766/j.cnki.issn.1674-4152.004371

腹透1年时血清白蛋白变化对腹膜透析患者死亡风险的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.004371

西安交通大学第一附属医院肾脏内科，陕西西安 710061

基金项目:

陕西省自然科学基础研究计划项目 2022JM-598

西安交通大学第一附属医院临床科研课题面上项目 XJTU1AF-CRF-2019-017

详细信息

通讯作者:
吕晶，E-mail：drlvjing@163.com

中图分类号: R459.5
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出版历程
- 收稿日期: 2025-03-24
- 网络出版日期: 2026-04-11

The predictive value of serum albumin changes at 1 year of peritoneal dialysis for the risk of death in peritoneal dialysis patients

Department of Nephrology, the First Affiliated Hospital of Xi ' an Jiaotong University, Xi ' an, Shaanxi 710061, China

摘要

摘要: 目的透析前低蛋白血症影响腹膜透析患者生存，白蛋白(ALB)改善对生存率作用的研究较少。本研究结合随访数据，分析腹膜透析1年时ALB变化对患者预后的影响。方法回顾分析西安交通大学第一附属医院肾脏内科2015年1月—2019年12月新置管并规律随访超过1年的356例PD患者资料。根据透析前、透析1年时ALB是否≥35 g/L及其变化, 分为持续ALB低水平组(A组，66例)、ALB升高组(B组，113例)、ALB降低组(C组，24例)、持续ALB高水平组(D组，153例)。采用Kaplan-Meier法比较不同组累积生存率，采用Cox风险回归模型评估全因死亡风险。结果与透析1年ALB≥35 g/L患者比较，ALB < 35 g/L者肌酐、血红蛋白、握力较低，超敏CRP、腹膜蛋白清除率较高。多因素logistic回归显示，透析初始月高腹膜蛋白清除率(OR=1.023，P < 0.001)、低握力(OR=0.947，P=0.020)、透析1年时高超敏CRP(OR=1.078，P=0.005)、水肿(OR=2.447，P=0.001)均是透析1年时ALB < 35 g/L的独立影响因素。Cox比例风险模型显示，透析1年时ALB < 35 g/L是腹透患者死亡的独立影响因素(OR=3.164，P=0.001)。结论透析初始月高腹膜蛋白清除率及低握力，高超敏CRP、水肿是预测透析1年时ALB < 35 g/L的独立危险因素。透析后ALB升高可明显降低腹膜透析患者的死亡风险。
- 腹膜透析 /
- 死亡风险 /
- 白蛋白 /
- 腹膜蛋白清除率 /
- 握力
Abstract: Objective Hypoalbuminemia before dialysis affects the survival of peritoneal dialysis (PD) patients, but studies on the effect of albumin improvement on survival rate are limited. This study uses follow-up data to analyze the impact of changes in albumin (ALB) levels after one year of PD on patients ' prognosis. Methods A total of 356 PD patients who underwent new catheterization in the Department of Nephrology, the First Affiliated Hospital of Xi ' an Jiaotong University from January 2015 to December 2019 and received regular follow-up for more than 1 year were retrospectively analyzed. According to their ALB levels at baseline and during one year of dialysis, the patients were divided into continuous low ALB group (group A, n=66), ALB increased group (group B, n=113), ALB decreased group (group C, n=24), and continuous high ALB group (group D, n=153). The Kaplan-Meier method was used to compare the cumulative survival rate among different groups, and the Cox proportional hazards regression model was used to evaluate the risk of all-cause mortality. Results Compared with patients whose ALB ≥35 g/L at 1 year of peritoneal dialysis, those with an ALB level of < 35 g/L had significantly lower creatinine, haemoglobin, and handgrip strength levels, while their high-sensitivity C-reactive protein (hs-CRP) and peritoneal protein clearance levels were significantly higher. Multivariate stepwise logistic regression showed that initial high peritoneal protein clearance rate (OR=1.023, P < 0.001) and low grip strength (OR=0.947, P=0.020), high hs-CRP (OR=1.078, P=0.005), and edema (OR=2.447, P=0.001) were independent influencing factors for albumin < 35 g/L at 1 year of peritoneal dialysis. The Cox proportional hazards model showed that albumin < 35 g/L at 1 year of dialysis was an independent influencing factor for death in peritoneal dialysis patients (OR=3.164, P=0.001). Conclusion High peritoneal protein clearance and low handgrip strength in the first month of peritoneal dialysis, high hs-CRP levels and edema, are independent risk factors for predicting albumin < 35 g/L at 1 year of peritoneal dialysis. An increase in post-dialysis ALB can significantly reduce the mortality risk in peritoneal dialysis patients.
- Peritoneal dialysis /
- Risk of death /
- Albumin /
- Peritoneal protein clearance /
- Handgrip strength

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图 1 透析1年PD患者不同白蛋白变化组的Kaplan-Meier生存曲线

Figure 1. Kaplan-Meier survival curves for different albumin change groups of PD patients

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表 1 不同白蛋白组PD患者基线资料比较

Table 1. Comparison of baseline data for PD patients in different groups

组别	例数	年龄(x±s，岁)	性别(男性/ 女性, 例)	糖尿病史[例(%)]	SBP (x±s，mmHg)	DBP (x±s，mmHg)	尿量[M(P₂₅, P₇₅), mL]	尿蛋白定量[M(P₂₅, P₇₅), g/24 h]	白蛋白(x±s，g/L)	血红蛋白(x±s，g/L)
AC组	90	53.74±16.37	42/48	24(26.7)	139.51±19.33	82.56±10.81	900.00(627.50, 1 200.00)	1.39(0.53, 1.94)	31.40±5.61	79.76±19.08
BD组	266	46.90±13.74	157/109	45(16.9)	136.99±19.99	84.77±12.16	1 100.00(750.00, 1 500.00)	1.17(0.55, 2.29)	35.32±5.32	84.81±19.34
统计量		3.869^a	4.165^b	4.091^b	0.874^a	1.504^a	-2.728^c	0.461^c	5.958^a	2.097^a
P值		< 0.001	0.041	0.043	0.305	0.133	0.006	0.984	< 0.001	0.037

组别	例数	尿素[M(P₂₅, P₇₅), mmol/L]	肌酐[M(P₂₅, P₇₅), μmol/L]	eGFR[M(P₂₅, P₇₅), mL/(min·1.73m²)]	高/高平均转运比例[例(%)]	TKt/V (x±s)	TCCr [M(P₂₅, P₇₅), %]	PCL [M(P₂₅, P₇₅), mL/d]	握力(x±s, kg)
AC组	90	29.53 (21.01, 36.97)	728.10 (588.92, 890.18)	8.05(6.24, 10.69)	36(59.8)	2.15±0.57	78.92 (65.32, 103.43)	69.23 (45.34, 88.14)	19.53±8.96
BD组	266	29.37 (22.51, 36.15)	782.80 (679.95, 930.50)	7.81(6.08, 9.74)	159(40.0)	2.15±0.59	87.65 (67.36, 107.51)	56.18 (39.51, 72.71)	25.10±10.42
统计量		-0.018^c	-2.562^c	1.573^c	10.615^b	0.017^a	-1.340^c	-3.073^c	4.154^a
P值		0.985	0.010	0.116	0.001	0.987	0.180	0.002	< 0.001
注：^a为t值，^b为χ²值，^c为Z值。1 mmHg=0.133 kPa。

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表 2 透析1年PD患者生化指标及溶质清除指标比较

Table 2. Comparison of biochemical indicators and solute clearance indicators for PD patients in the first year of peritoneal dialysis

组别	例数	白蛋白(x±s，g/L)	尿素(x±s，mmol/L)	肌酐[M(P₂₅, P₇₅), μmol/L]	血红蛋白(x±s，g/L)	超敏CRP [M(P₂₅, P₇₅), mg/L]	rGFR[M(P₂₅, P₇₅), mL/(min·1.73 m²)]
AC组	90	31.13±3.78	17.90±6.43	665.50(528.25, 886.00)	95.44±19.69	2.31(0.69，5.98)	2.05(0.59, 4.34)
BD组	266	39.79±3.08	18.23±4.69	784.50(615.75, 970.50)	108.35±14.43	1.24(0.50，3.18)	2.56(1.40, 4.21)
统计量		21.425^a	0.413^a	-2.830^b	6.600^a	1.394^b	-1.901^b
P值		< 0.001	0.680	0.005	< 0.001	0.042	0.057

组别	例数	尿量[M(P₂₅, P₇₅), mL]	TKt/V (x±s)	TCCr [M(P₂₅, P₇₅), %]	PCL [M(P₂₅, P₇₅), mL/d]	握力(x±s，kg)
AC组	90	525(225, 948)	2.06±0.57	71.30(54.70, 97.13)	83.58(64.18, 83.58)	22.41±9.04
BD组	266	750(400, 1 050)	2.08±0.57	76.75(60.27, 96.87)	53.57(41.43, 66.62)	27.27±9.56
统计量		-2.600^b	0.334^a	-0.795^b	-7.454^b	4.494^a
P值		0.009	0.739	0.426	< 0.001	< 0.001
注：^a为t值，^b为Z值。

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表 3 透析1年PD患者白蛋白 < 35 g/L风险的多因素logistic回归模型

Table 3. Multivariate stepwise logistic regression model for the risk for PD patients of serum albumin levels below 35 g/L after 12 months of peritoneal dialysis

变量	B	SE	Waldχ²	P值	OR值	95% CI
透析初始月PCL	0.023	0.006	13.011	< 0.001	1.023	1.011~1.036
透析初始月握力	-0.054	0.023	5.416	0.020	0.947	0.905~0.992
透析1年超敏CRP	0.076	0.027	7.978	0.005	1.078	1.023~1.137
透析1年水肿	0.895	0.259	11.919	0.001	2.447	1.472~4.067
注：将透析1年白蛋白作为因变量，透析1年白蛋白 < 35 g/L=1，透析1年白蛋白≥35 g/L=0；透析初始月握力、PCL、透析1年超敏CRP为连续变量，均以实际值赋值；透析1年水肿为分类变量，有=1，无=0。

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表 4 透析1年PD患者白蛋白动态变化的死亡率影响的Cox比例风险模型

Table 4. Cox proportional hazards modelling of the impact of dynamic changes in albumin over one year of dialysis for PD patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
透析前白蛋白 < 35 g/L	0.412	0.332	1.534	0.216	1.509	0.787~2.896
1年白蛋白 < 35 g/L	1.152	0.310	13.777	0.001	3.164	1.722~5.814
A组	1.782	0.572	9.719	0.002	5.944	1.938~18.227
B组	0.967	0.546	3.137	0.077	2.629	0.902~7.663
C组	1.934	0.526	13.500	< 0.001	6.918	2.466~19.412
注：将是否死亡作为因变量，是=1，否=0。透析前白蛋白 < 35 g/L、1年白蛋白 < 35 g/L=1，否则赋值为0。组间比较时将D组作为对照，OR值设为1，其他各组均与D组进行比较。

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表 5 各组PD患者不同时间点握力和PCL比较

Table 5. Comparison of grip strength and PCL in PD patients at different time points in each group

组别	例数	握力(x±s，kg)		t值	P值	PCL[M(P₂₅, P₇₅), mL/d]		Z值	P值
组别	例数	初始月	透析1年	t值	P值	初始月	透析1年	Z值	P值
A组	66	19.03±8.93	20.57±8.83	1.807	0.066	71.73(50.79, 88.14)	85.57(67.42, 110.45)	-2.315	0.021
B组	113	24.91±9.15	26.82±9.12	2.259	0.029	66.52(49.82, 86.06)	57.44(43.91, 70.68)	-2.538	0.011
C组	24	18.64±8.62	19.45±7.68	1.361	0.619	70.09(48.31, 95.58)	73.98(60.75, 123.45)	-1.288	0.198
D组	153	23.98±9.85	25.93±8.63	3.688	< 0.001	49.99(37.02, 67.43)	51.91(37.73, 65.16)	-0.147	0.883

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