Szeto Cheuk-Chun, Kwan Bonnie Ching-Ha, Chow Kai-Ming, Leung Chi-Bon, Cheng Mei-Shan, Law Man-Ching, Li Philip Kam-Tao
From Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Clin J Am Soc Nephrol. 2014 Apr;9(4):779-87. doi: 10.2215/CJN.06620613. Epub 2014 Jan 23.
In the general population, metabolic syndrome (MES) is associated with cardiovascular risk. However, the definition of MES and its prognostic implication among patients undergoing peritoneal dialysis (PD) remain controversial.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 329 prevalent PD patients from April 2008 to April 2011 and compared four sets of diagnostic criteria: the original World Health Organization (WHO) criteria, the International Diabetes Federation (IDF) criteria, the original National Cholesterol Education Program (NCEP) criteria, and the modified NCEP criteria. Nutritional status, body composition, and arterial pulse-wave velocity were measured. Patients were followed for 31.7 ± 15.5 months.
Among the 329 patients, 175 (53.2%) fulfilled the WHO criteria, 177 (53.8%) the IDF criteria, 199 (60.5%) the original NCEP criteria, and 218 (66.3%) the modified NCEP criteria. The agreement among the four sets of criteria was fair to moderate (Cohen κ=0.35-0.58). Patients with MES defined by all four criteria had higher adipose tissue mass than the others, although the difference in adipose tissue mass was most pronounced with the IDF criteria (MES versus no MES, 18.2 ± 7.9 versus 10.7 ± 5.9 kg; P<0.001). Patients with MES, as defined by the IDF criteria, were hospitalized longer than those without MES (3.82 [interquartile range, 0.00-12.61] versus 1.07 [interquartile range, 0.00-6.43]) days per year of follow-up; P=0.01). Overall survival, cardiovascular survival, or technique survival did not differ between patients with and without MES, irrespective of the diagnostic criteria after adjustment for diabetic status.
In patients undergoing PD, overall survival, cardiovascular survival, and technique survival did not differ between patients with and without MES, irrespective of diabetic status and diagnostic criteria. Further studies are needed to establish a new definition or clinical scoring system for risk stratification of PD patients.
在普通人群中，代谢综合征（MES）与心血管风险相关。然而，MES的定义及其在腹膜透析（PD）患者中的预后意义仍存在争议。
设计、地点、参与者及测量方法：我们研究了2008年4月至2011年4月期间的329例维持性PD患者，并比较了四套诊断标准：世界卫生组织（WHO）的原始标准、国际糖尿病联盟（IDF）标准、美国国家胆固醇教育计划（NCEP）的原始标准以及修订后的NCEP标准。测量了营养状况、身体成分和动脉脉搏波速度。对患者进行了31.7±15.5个月的随访。
在这329例患者中，175例（53.2%）符合WHO标准，177例（53.8%）符合IDF标准，199例（60.5%）符合NCEP原始标准，218例（66.3%）符合修订后的NCEP标准。四套标准之间的一致性为中等至良好（Cohen κ=0.35 - 0.58）。根据所有四套标准定义为MES的患者，其脂肪组织量高于其他患者，尽管脂肪组织量的差异在IDF标准下最为明显（MES组与非MES组，分别为18.2±7.9 kg与10.7±5.9 kg；P<0.001）。根据IDF标准定义为MES的患者，其住院时间比非MES患者长（随访每年分别为3.82天[四分位数间距，0.00 - 12.61]与1.07天[四分位数间距，0.00 - 6.43]；P = 0.01）。无论诊断标准如何，调整糖尿病状态后，有或无MES的患者在总生存期、心血管生存期或技术生存期方面并无差异。
在接受PD治疗的患者中，无论糖尿病状态和诊断标准如何，有或无MES的患者在总生存期、心血管生存期和技术生存期方面并无差异。需要进一步研究以建立用于PD患者风险分层的新定义或临床评分系统。
