代谢综合征对印度非糖尿病腹膜透析患者临床结局的影响。

Effect of metabolic syndrome on clinical outcomes of non-diabetic peritoneal dialysis patients in India.

机构信息

Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

出版信息

Nephrology (Carlton). 2013 Oct;18(10):657-64. doi: 10.1111/nep.12124.

DOI:10.1111/nep.12124

PMID:23834643

Abstract

AIM

Metabolic syndrome (MS) is associated with higher mortality and morbidity in the general population. However, the effect of MS and its individual components on clinical outcomes in non-diabetic peritoneal dialysis (PD) patients has not been widely studied in India. Our aim was to study the prevalence of MS in non-diabetic PD patients who were on PD for at least 3 months and to analyze the influence of MS and its individual components on clinical outcomes of these patients on subsequent follow up.

METHODS

We prospectively included 163 non-diabetic PD patients (mean age 45.1 ± 16.2 years, 104 male). MS was defined using the modified National Cholesterol Education Programme (ATP III) criteria. Outcomes of patients with and without MS were compared.

RESULTS

Of the 163 non-diabetic PD patients, 84 (51.5%) patients had MS. The mean follow up duration was 24.0 ± 14.0 patient months. Patients with MS had significantly greater body mass index (P = 0.007), Systolic BP (P = 0.001), diastolic BP (P = 0.001), Triglycerides (P = 0.002), total cholesterol (P = 0.001) level; and significantly lower high density lipoprotein (P = 0.013) values. Mean survival (patient-months) of patients with MS (30.7 (95%CI 27.1-34.3)) was significantly inferior to that of patients without MS (55.6 (95% CI 50.8-60.4), P = 0.001). Mean technique survival of patients with MS was also significantly lower (38.9 (95% CI 35.9-41.9)) compared to that of patients without MS (61.5 (95% CI 58.3-64.7), P = 0.039). On univariate Cox regression analysis diastolic BP (P = 0.003), Systolic BP (P = 0.026), hypertension (HTN) (P = 0.001) and MS (P = 0.001) were found to be independent predictors of mortality. However on multivariate Cox hazard regression analysis, only MS (HR 5.39 (95% CI 2.06-14.14), P = 0.001) was found to be the significant predictors of mortality in these patients. Among the factors other than components of MS, the presence of comorbidities (P = 0.029), serum albumin (P = 0.042), non-HDL cholesterol (P = 0.003), total cholesterol/HDL (P = 0.001) and MS (P = 0.001) were important factors predicting mortality on univariate Cox regression, while only MS (P = 0.001) and serum albumin (P = 0.013) were the independent factors predicting mortality on multivariate analysis.

CONCLUSION

Prevalence of MS in non-diabetic PD patient is high and predicts long term patient and technique survival.

摘要

目的

代谢综合征（MS）与普通人群的更高死亡率和发病率相关。然而，MS 及其各个组成部分对非糖尿病腹膜透析（PD）患者的临床结果的影响在印度尚未得到广泛研究。我们的目的是研究至少接受 3 个月 PD 治疗的非糖尿病 PD 患者中 MS 的患病率，并分析 MS 及其各个组成部分对这些患者随后随访期间临床结果的影响。

方法

我们前瞻性纳入了 163 名非糖尿病 PD 患者（平均年龄 45.1±16.2 岁，104 名男性）。使用改良的国家胆固醇教育计划（ATP III）标准定义 MS。比较了有和没有 MS 的患者的结局。

结果

在 163 名非糖尿病 PD 患者中，84 名（51.5%）患者患有 MS。平均随访时间为 24.0±14.0 患者月。MS 患者的体重指数（P=0.007）、收缩压（P=0.001）、舒张压（P=0.001）、甘油三酯（P=0.002）、总胆固醇（P=0.001）水平显著更高，高密度脂蛋白（P=0.013）水平显著更低。MS 患者的平均生存（患者月）（30.7（95%CI 27.1-34.3））明显低于无 MS 患者（55.6（95%CI 50.8-60.4），P=0.001）。MS 患者的平均技术生存（38.9（95%CI 35.9-41.9））也明显低于无 MS 患者（61.5（95%CI 58.3-64.7），P=0.039）。单变量 Cox 回归分析显示，舒张压（P=0.003）、收缩压（P=0.026）、高血压（HTN）（P=0.001）和 MS（P=0.001）是死亡的独立预测因素。然而，多变量 Cox 风险回归分析显示，只有 MS（HR 5.39（95%CI 2.06-14.14），P=0.001）是这些患者死亡的显著预测因素。在 MS 以外的其他因素中，合并症的存在（P=0.029）、血清白蛋白（P=0.042）、非高密度脂蛋白胆固醇（P=0.003）、总胆固醇/高密度脂蛋白（P=0.001）和 MS（P=0.001）是死亡的重要预测因素在单变量 Cox 回归中，而只有 MS（P=0.001）和血清白蛋白（P=0.013）是死亡的独立预测因素在多变量分析中。