腹膜透析患者腹腔可溶性白细胞介素6受体预测腹膜超滤不良的价值
Value of intraperitoneal soluble interleukin-6 receptor in predicting ultrafiltration insufficiency in peritoneal dialysis patients
李菡 1牛威 1苏新玙 1沈亦蔚 1严豪 1李振元 1俞赞喆 1袁江姿 1姜娜 1黄佳颖 1倪兆慧 1顾乐怡 1方炜1
作者信息
- 1. 上海交通大学医学院附属仁济医院肾脏内科 上海市腹膜透析研究中心,上海 200127
- 折叠
摘要
目的 探讨腹腔可溶性白细胞介素6(interleukin-6,IL-6)受体(soluble IL-6 receptor,sIL-6R)水平对腹膜透析(腹透)患者发生超滤不良的预测价值.方法 该研究为前瞻性队列研究,研究对象为2016年11月至2018年7月在上海交通大学医学院附属仁济医院腹透中心接受持续非卧床腹透治疗且规律随访的患者.酶联免疫吸附法测定患者透出液中sIL-6R浓度,按sIL-6R呈现率的中位数将患者分为高sIL-6R呈现率组和低sIL-6R呈现率组.随访终点为患者死亡,或退出腹透,或研究终止日期(2022年12月31日).采用多元线性回归分析法分析sIL-6R呈现率的相关因素.采用Kaplan-Meier法和Log-rank检验比较高sIL-6R呈现率组和低sIL-6R呈现率组患者无超滤不良生存率的差异.采用多因素Cox回归及多因素竞争风险模型分析发生超滤不良的风险因素.结果 共198例腹透患者入选该研究,男性115例(58.1％),年龄(54.9±13.7)岁,透析龄22.5(6.6,65.0)个月,sIL-6R呈现率为2 094.7(1 672.4,2 920.9)pg/min.与低sIL-6R呈现率(＜2 094.7 pg/min)组比较,高sIL-6R呈现率(＞2 094.7 pg/min)组患者年龄(t=-3.269,P=0.001)、体重指数(t=-3.248,P=0.001)、合并糖尿病比例(x2=8.890,P=0.003)、24h葡萄糖暴露量(Z=-2.257,P=0.024)、24 h超滤量(Z=-2.515,P=0.012)、4 h透析液肌酐与血肌酐比值(t=-2.609,P=0.010)、肌酐的物质转运面积系数(Z=-2.308,P=0.021)、IL-6呈现率(Z=-3.533,P＜0.001)和可溶性糖蛋白130呈现率(Z=-8.670,P＜0.001)均较高,血清白蛋白(t=2.595,P=0.010)和残肾功能(t=2.133,P=0.033)均较低.多元线性回归分析结果显示,体重指数(β=0.194,P=0.005)、血清白蛋白(β=-0.215,P=0.002)和 lg[IL-6呈现率](β=0.197,P=0.011)与患者腹腔sIL-6R呈现率独立相关.至研究终点,57例(28.8％)患者发生超滤不良.Kalpan-Meier生存分析结果显示,高sIL-6R呈现率组患者无超滤不良生存率显著低于低sIL-6R呈现率组(Log-rank x2=5.375,P=0.020).多因素Cox回归及多因素竞争风险模型分析结果显示,透出液高sIL-6R呈现率水平(＞2094.7 pg/min)是腹透患者发生超滤不良的独立影响因素(HR=2.286,95％CI 1.254～4.165,P=0.007;SHR=2.074,95％CI1.124～3.828,P=0.020).结论 腹透患者透出液sIL-6R水平与体重指数、血清白蛋白和透出液IL-6水平相关,高sIL-6R水平是腹透患者发生超滤不良的预测因素.
Abstract
Objective To investigate the value of soluble interleukin-6(IL-6)receptor(sIL-6R)level in predicting ultrafiltration insufficiency in peritoneal dialysis(PD)patients.Methods It was a prospective cohort study.The patients who received continuous ambulatory PD and regular follow-up between November 2016 and July 2018 in the PD Center of Renji Hospital,School of Medicine,Shanghai Jiao Tong University were enrolled.Enzyme-linked immunosorbent assay was used to determine dialysate sIL-6R and its appearance rate(AR)was calculated.Patients were divided into high sIL-6R AR group and low sIL-6R AR group according to median value of sIL-6R AR and prospectively followed up until death,PD cessation,or the end of the study(December 31,2022).Multiple linear regression was used to analyze the related factors of sIL-6R AR.Kaplan-Meier method and log-rank test were used to compare the survival rate difference of ultrafiltration insufficiency between high sIL-6R AR group and low sIL-6R AR group.Multivariate Cox regression and multivariate competing risk models were used to assess the risk factors associated with occurrence of ultrafiltration insufficiency.Results A total of 198 PD patients were enrolled,including 115(58.1％)males,with age of(54.9±13.7)years old and PD duration of 22.5(6.6,65.0)months.The sIL-6R AR of the cohort was 2 094.7(1 672.4,2 920.9)pg/min.Compared with low sIL-6R AR(＜2 094.7 pg/min)group,high sIL-6R AR(＞2 094.7 pg/min)group had older age(t=-3.269,P=0.001),higher body mass index(t=-3.248,P=0.001),proportion of combined diabetes mellitus(x2=8.890,P=0.003),24 h glucose exposure(Z=-2.257,P=0.024),24 h ultrafiltration capacity(Z=-2.515,P=0.012),4 h dialysate creatinine to serum creatinine ratio(t=-2.609,P=0.010),mass transfer area coefficient of creatinine(Z=-2.308,P=0.021),IL-6 AR(Z=-3.533,P＜0.001)and solute glycoprotein 130 AR(Z=-8.670,P＜0.001),and lower serum albumin(t=2.595,P=0.010)and residual renal function(t=2.133,P=0.033).Multiple linear regression analysis showed that body mass index(β=0.194,P=0.005),serum albumin(β=-0.215,P=0.002)and dialysate lg[IL-6 AR](β=0.197,P=0.011)were independently correlated with sIL-6R AR.By the end of the study,57(28.8％)patients developed ultrafiltration insufficiency.Kaplan-Meier analysis showed that high sIL-6R AR group had a significantly inferior ultrafiltration insufficiency-free survival rate than that in low sIL-6R AR group(log-rank x2=5.375,P=0.020).Multivariate Cox regression analysis and multivariate competing risk models showed that high dialysate sIL-6R AR(＞2 094.7 pg/min)was an independent influencing factor of ultrafiltration insufficiency(HR=2.286,95％CI 1.254-4.165,P=0.007;SHR=2.074,95％CI 1.124-3.828,P=0.020)in PD patients.Conclusions Dialysate sIL-6R level was associated with body mass index,serum albumin and dialysate IL-6 level.Dialysate sIL-6R may be a predictive factor of ultrafiltration insufficiency in PD patients.
关键词
腹膜透析/炎症/超滤/可溶性白细胞介素6受体Key words
J Peritoneal dialysis/Inflammation/Ultrafiltration/Soluble interleukin-6 receptor引用本文复制引用
基金项目
国家自然科学基金(81370864)
国家自然科学基金(81670691)
上海市教育委员会高峰高原学科建设计划(20152211)
出版年
2024
NETL
NSTL
万方数据