【摘要】目的分析腹膜透析患者容量超负荷的独立危险因素，建立风险评估模型，为早期识别容量超负荷患者及制订干预措施提供依据。方法纳入2019 年1 月～12 月在宁夏医科大学总医院腹膜透析中心接受透析治疗符合入组的129 例腹膜透析患者。以水负荷(overdydration, OH)值来评估患者的容量状态，OH值≤2.5L为容量正常组(n=48)，OH值＞2.5 L 为容量超负荷组(n=81)，比较2组患者危险因素。结果容量超负荷组收缩压、总体水、细胞外液、细胞内液显著高于容量正常组(t/Z 值分别为-2.664, -3.237, -2.572, -2.469; P 值分别为0.009, 0.002, 0.012, 0.004)，而血清白蛋白、尿量显著低于容量正常组(t/Z 值分别为4.514, 1.979; P值分别为＜0.001, 0.001)；多因素Logistic 回归分析结果显示，尿量、收缩压、血清白蛋白是腹膜透析患者容量超负荷的独立危险因素(OR 值分别为1.001，0.996，1.193; 95%CI 分别为1.001～1.002，0.938～0.994，1.088～1.308; P 值分别为0.001，0.019，＜0.001)；模型的ROC 曲线下面积AUC=0.845，最大约登指数0.539；该模型预测敏感性为90.1%，特异性为62.5%，总符合率73.6%。结论尿量、收缩压、血清白蛋白是腹膜透析患者容量负荷的独立危险因素。
【Abstract】Objective To explore the independent risk factors for volume overload, and to develop a risk prediction model for volume overload in patients with peritoneal dialysis (PD). Methods A total of 129 PD patients treated in the period from January to December 2019 were recruited in this study. Overhydration (OH) value was assessed by multiple-frequency bioelectrical impedance. OH >2.5 L (n=81) was assigned as volume overload, and OH ≤2.5L (n=48) as normal volume status. Clinical manifestations were compared between the two groups. Results Compare with the normal volume patient group, systolic blood pressure, total water (TBW), extracellular water (ECW) and intracellular water (ICW) were significantly higher (P<0.05), while serum albumin and residual urine volume were significantly lower in the volume overload group (P<0.05). Logistic regression analysis found that urine volume (β =0.001, OR=1.001, 95% Cl 1.001- 1.002, P=0.001), systolic blood pressure (β=-1.320, OR=0.966, 95% Cl 0.938-0.994, P=0.019), and serum albumin (β=0.176, OR=1.193, 95% Cl 1.088- 1.308, P=0.000) were the independent risk factors for volume load. The ROC curve showed that AUC=0.845, the most approximate index=0.539, the predictive sensitivity=90.1%, the specificity=62.5%, and the total coincidence rate=73.6%. Conclusion Urine volume, systolic blood pressure and serum albumin were the independent risk factors for volume overload in PD patients.
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