【摘要】目的确定腹膜透析患者经透析液吸收葡萄糖的能量和新发糖尿病或糖耐量受损(new-onset diabetes/impaired glucose tolerance, NODI)的关系。方法回顾性单中心的队列研究，入选所有2007 年8 月～2011 年8 月的非糖尿病腹膜透析患者。记录基线人口学资料，基线及随后每3 个月的生化参数、透析处方、透析充分性和营养参数，计算经透析液吸收的葡萄糖和能量，建立基线和时间平均变量的多元Cox 回归模型来预测NODI 的危险因素。结果共入选256 名腹膜透析患者，平均随访32.4(12.9～60.8)个月，有25(4.1%)例患者诊断为新发糖尿病，7(1.1%)例患者诊断为糖耐量受损。时间平均的经透析液吸收葡萄糖的能量为(310.9± 120.1)kcal/天。多变量Cox 回归分析发现，经透析液吸收葡萄糖的能量(HR=1.000,95% CI 0.996～1.005,P=0.883)并不预测NODI 的风险，时间平均的体质量指数(HR=1.194,95% CI 1.067～1.335,P=0.002)是NODI 的独立危险因素。结论腹膜透析患者经透析液吸收葡萄糖的能量并不预测NODI的发生。

【Abstract】Objectives To identify the relationship between energy absorbed from glucose in dialysate and new-onset diabetes/impaired glucose tolerance (NODI) in patients on peritoneal dialysis (PD). Methods In this retrospective and single center-based cohort study, all non-diabetic incident PD patients between August 2007 and August 2011 were enrolled. Their demographic and laboratory data were recorded at baseline. Repeated measurements for laboratory, dialysis prescription, and nutrition parameters were recorded at regular intervals. Multivariate Cox regression models built from baseline and time-dependent variables were used to calculate the hazard ratio (HR) of potential predictors for NODI. Results Of the 256 PD patients in a mean follow-up period of 32.4 (12.9～60.8) months, 25 (4.1%) and 7 (1.1%) patients were identified with new-onset diabetes and impaired glucose tolerance, respectively. The average energy absorbed from dialysate was 310.9±120.1 kcal/d. Using multivariate Cox regression analysis, we found that time- dependent BMI (HR=
1.194, 95% CI 1.067～1.335, P=0.002) independently predicted the risk for NODI, but energy absorbed from dialysate (HR=1.000, 95% CI 0.996～1.005, P=0.883) and other laboratory parameters either of the baseline or the time-dependent ones were not correlated with the risk for NODI. Conclusions Energy absorbed from dialysate doesn’t contribute to NODI in PD patients.