摘要目的 分析接受腹膜透析治疗的终末期多囊肾患者的疗效及预后.方法 回顾性分析2007年7月至2016年9月在苏州大学附属第二医院接受腹膜透析治疗3个月以上的多囊肾患者45例,选择性别、年龄与之匹配的非糖尿病肾病腹膜透析患者45例为对照组,收集和记录两组患者的一般资料、透析相关并发症、腹膜炎发生率和转归等临床资料,用Kaplan-Meier曲线法比较两组患者生存率,并进行Log-rank检验;Cox回归模型法分析影响患者生存率的危险因素.结果 多囊肾组与对照组患者进入透析年龄、性别比例、血压、24 h尿量、体重、估算肾小球滤过率(eGFR)、血尿生化指标、合并高血压及糖尿病比例、24 h腹膜透析超滤量、4h腹透液肌酐/血肌酐(D/Per)比值,尿素清除指数(Kt/V),肌酐清除率(Ccr)等项目的差异无统计学意义(均P＞ 0.05).多囊肾组和对照组患者腹膜炎的发生率分别为1次/82.4患者·月比1次/81.5患者·月;首次腹膜炎发生时间为(35.8±22.8)个月比(34.5±20.9)个月,组间比较差异无统计学意义;两组患者疝、胸腹漏、腹透管功能不良、出口感染、隧道感染及非腹透相关感染发生率的差异亦无统计学意义.多囊肾组和对照组患者1、3、5年生存率分别为95.2％比93.3％,78.9％比75.0％,67.6％比64.9％;5年腹透管技术生存率分别为78.7％比76.7％,差异均无统计学意义(均P＞0.05).Cox回归模型分析结果显示年龄、血Alb是影响患者生存的危险因素.结论 多囊肾与非多囊肾患者腹膜透析治疗的疗效及预后相似,腹膜透析不是多囊肾的禁忌证,可作为多囊肾患者常规的肾脏替代治疗方式.

abstractsObjective To analyze the therapeutic effect and prognosis of peritoneal dialysis in patients with end-stage polycystic kidney disease.Methods A retrospective analysis was performed on patients with polycystic kidney disease who were treated with peritoneal dialysis for more than 3 months between July 2007 and September 2016 in the Second Hospital Affiliated to Soochow University.A total of 45 patients were enrolled in this study.Another 45 patients of non-diabetic nephropathy were selected as the control group matched by gender,age,and time of PD initiation.The information of the two groups such as general data,dialysis related complications,incidence of peritonitis,prognosis was recorded.Survival analysis was performed using the Kaplan-Meier method and Log-rank test.The risk factors affecting patients' survival were analyzed with Cox regression model.Results There were no significant difference in pre-dialysis age,sex ratio,blood pressure,urine volume,body weight,eGFR,biochemical data,and the proportion of hypertension and diabetes mellitus in the polycystic kidney group and control group.24 h ultra-filtration volume,4 h D/Pcr,Kt/V and Ccr between the two groups showed no significant difference (all P ＞ 0.05).The incidence of peritonitis and the time of the first peritonitis in the two groups respectively as one episode per 82.4 months vs one episode per 81.5 months,(35.8±22.8) months vs (34.5±20.9) months had no statistical difference.The ratio of hernia (6.6％ vs 2.2％),thoracic and abdominal leakage (4.4％ vs 2.2％),dialysate leakage (0 vs 0),catheter dysfunction (4.4％ vs 6.6％),exit-site infections (11.1％ vs 6.6％),tunnel infections (4.4％ vs 2.2％) and non PD related infections (11.1％ vs 13.3％) had no significant difference.The 1-year,3-year,5-year patient survival of two groups respectively were 95.2％ vs 93.3％,78.9％ vs 75.0％,67.6％ vs 64.9％ (P=0.475),and 5-year technique survival was 78.7％ vs 76.7％ (P=0.623),demonstrating no obvious difference.Cox regression analysis showed that age and serum albumin were risk factors for the survival of patients.Conclusions The effect and prognosis of peritoneal dialysis in patients with polyeystic kidney and non polyeystic kidney were similar.Peritoneal dialysis is not the contraindication of polycystic kidney.Peritoneal dialysis can be used as a routine renal replacement therapy in patients with polycystic kidney disease.