持续非卧床腹膜透析患者容量超负荷状态影响因素及与微炎症指标和营养状态的关系分析OA

Objective To investigate the influencing factors of volume overload status in patients undergoing continuous ambulatory peritoneal dialysis(CAPD)and its relationship with micro-inflammatory markers and nutritional status.Methods A total of 109 CAPD patients admitted from June 2021 to December 2023 were selected as the research subjects.According to occurrence of volume overload,the patients were divided into the normal volume group(n=59)and the volume overload group(n=50).The general information,dialysis-related indicators,micro-inflammatory markers[interleukin-6(IL-6),C reactive protein(CRP),tumor necrosis factor-α(TNF-α)],and nutritional status[serum albumin,total protein,transferrin(TRF),retinol binding protein(RBP),total cholesterol(TC),triglyceride(TG)]of the two groups were compared.The correlation between micro-inflammation markers and nutritional status indicators in CAPD patients was analyzed,binary logistic regression was used to analyze the influencing factors of volume load in patients,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of micro-inflammation and nutritional status indicators for volume overload status in CAPD patients.Results The systolic blood pressure(SBP),extracellular fluid,extracellular fluid/total fluid,and extracellular fluid/intracellular fluid levels in the volume overload group were higher than those in the normal volume group,and the weekly urea clearance index was lower than that in the normal volume group(P＜0.01).The levels of serum IL-6,CRP and TNF-α in the volume overload group were higher than those in the normal volume group,while the albumin level was lower than that in the normal volume group(P＜0.01).There was no significant difference in the levels of total serum protein,TRF,RBP,TC and TG between the two groups(P＞0.05).Pearson correlation analysis showed that the micro-inflammatory markers IL-6,CRP,and TNF-α in patients with volume-overloaded CAPD were significantly negatively correlated with albumin(P＜0.05).SBP,weekly urea clearance index,extracellular fluid,extracellular fluid/total fluid,extracellular fluid/intracellular fluid,CRP,and albumin were all independent risk factors for volume overload in CAPD patients(P＜0.01).ROC curve analysis showed that the areas under the ROC curve of IL-6,CRP,TNF-α and albumin for diagnosing volume overload in CAPD patients were 0.697,0.946,0.750 and 0.866 respectively,with sensitivities of 48.00％,86.00％,66.00％and 70.00％respectively and specificities of 89.83％,100.00％,81.36％and 93.22％respectively.Conclusion The albumin level of CAPD patients is related to IL-6,CRP and TNF-α.SBP,weekly urea clearance index,extracellular fluid,extracellular fluid/total fluid,extracellular fluid/intracellular fluid,CRP,and albumin are independent risk factors for volume overload in CAPD patients.In clinical practice,volume overload in patients can be improved through measures such as strengthening adequate dialysis,controlling blood pressure,enhancing nutritional management,and anti-infection.