腹膜透析初期患者症状负担轨迹及其对近期心脑血管事件的影响

赵国庆; 卢慧娟; 莫惠娟

doi:10.16766/j.cnki.issn.1674-4152.004490

腹膜透析初期患者症状负担轨迹及其对近期心脑血管事件的影响

doi: 10.16766/j.cnki.issn.1674-4152.004490

杭州市临平区第一人民医院(浙大二院临平院区)肾内科, 浙江杭州 311100

基金项目:

杭州市医药卫生科技计划项目 B20231482

杭州市医药卫生科技计划项目 B20252729

浙江省中医药科技计划项目 2025ZX139

详细信息

通讯作者:
赵国庆，E-mail：18157189529@163.com

中图分类号: R459.5
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- 文章访问数: 8
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- 被引次数: 0
出版历程
- 收稿日期: 2025-08-29
- 网络出版日期: 2026-10-23

The symptom burden trajectory of patients in the early stage of peritoneal dialysis and its impact on recent cardiovascular and cerebrovascular events

Department of Nephrology, the First People's Hospital of Linping District, Hangzhou (Hangzhou Second Hospital Linping Branch), Hangzhou, Zhejiang 311110, China

摘要

摘要: 目的腹膜透析患者初期症状复杂且波动明显，但其动态变化规律尚不明确。本研究旨在分析腹膜透析初期患者症状负担的潜在轨迹类别，探究不同轨迹特征与近期心脑血管不良事件（CCE）发生风险的关联，为早期个体化干预及远期预后改善提供依据。方法选取2022年10月—2025年4月杭州市临平区第一人民医院腹膜透析初期患者为调查对象。透析2年统计近期CCE发生率。初次透析时（T0）、透析1个月（T1）、透析3个月（T2）、透析6个月（T3）时采用透析患者症状负担量表（DFSSBI）评估症状负担，通过潜变量增长混合模型（LGMM）对症状负担轨迹进行分类，采用logistic回归分析研究症状负担轨迹对近期CCE的影响。结果纳入的164例腹膜透析初期患者中最终150例完成调查，随访时间为3~32个月，中位随访时间为15个月，40例发生CCE，发生率为26.67%（40/150）。识别出腹膜透析初期患者症状负担轨迹有低水平稳定组（C1组）、中水平缓解组（C2组）、高水平波动组（C3组）3种。症状负担轨迹与近期CCE的发生均呈显著的线性趋势，C3组近期CCE发生率最高（P＜0.05）。结论腹膜透析初期患者症状负担轨迹存在群体异质性，持续高症状负担会增加患者近期CCE的发生风险。
- 腹膜透析 /
- 症状负担 /
- 轨迹 /
- 心脑血管事件
Abstract: Objective During the initial period of peritoneal dialysis, patients experience complex and fluctuating symptoms. However, the dynamic patterns of these changes remain unclear. This study aims to identify potential trajectories of symptom burden in patients undergoing the initial phase of peritoneal dialysis and to explore the association between different trajectory characteristics and the risk of short-term cardiovascular and cerebrovascular adverse events (CCE), thereby providing evidence for early individualized intervention and improved long-term prognosis. Methods Patients in the early stage of peritoneal dialysis in the First People's Hospital of Linping District, Hangzhou from October 2022 to April 2025 were selected as the survey subjects. The recent incidence of CCE was statistically analyzed after two years of dialysis. The dialysis frequency severity and symptom burden index (DFSSBI) was used to assess the symptom burden at the initial dialysis (T0), 1 month of dialysis (T1), 3 months of dialysis (T2), and 6 months of dialysis (T3). The symptom burden trajectory was classified through the latent variable growth mixed model (LGMM). Logistic regression was used to analyze the influence of symptom burden trajectory on recent CCE. Results Among the 164 patients in the early stage of peritoneal dialysis included, 150 patients eventually completed the investigation. The follow-up period ranged from 3 to 32 months, with a median follow-up period of 15 months. CCE occurred in 40 patients, with an incidence rate of 26.67% (40/150). It was identified that there were three symptom burden trajectories for patients in the early stage of peritoneal dialysis: the low-level stable group (C1 group), the medium-level remission group (C2 group), and the high-level fluctuation group (C3 group). The symptom burden trajectory showed a significant linear trend with the occurrence of recent CCE, and the incidence of recent CCE was the highest in group C3 (P < 0.05). Conclusion There is population heterogeneity in the symptom burden trajectory of patients in the early stage of peritoneal dialysis. A persistently high symptom burden will increase the risk of recent CCE events in patients.
- Peritoneal dialysis /
- Symptom burden /
- Trajectory /
- Cardiovascular and cerebrovascular events

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图 1 腹膜透析初期患者症状负担轨迹图

Figure 1. Trajectory of symptom burden in patients during initial peritoneal dialysis

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表 1 腹膜透析初期患者症状负担轨迹LGMM拟合指标(n=150)

Table 1. LGMM Fitting Index of symptom burden trajectory in Patients in the early stage of peritoneal dialysis(n=150)

模型	AIC	BIC	aBIC	entropy	LMRT (P值)	BLRT (P值)	类别概率(%)
1	6 328.514	6 522.321	6 423.158				100
2	6 020.342	6 324.518	6 241.226	0.891	0.003	＜0.001	30.02/69.98
3	5 881.024	6 010.258	5 923.121	0.902	0.013	＜0.001	28.00/45.33/26.67
4	5 596.257	5 795.327	5 600.205	0.897	0.032	＜0.001	25.68/8.15/41.92/24.25
5	5 283.428	5 492.688	5 305.772	0.925	0.181	＜0.001	20.03/11.15/30.49/25.89/12.44

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表 2 腹膜透析初期患者症状负担轨迹平均归属3个潜在类别的概率

Table 2. The average probability of patients in the early stage of peritoneal dialysis being classified into 3 potential categories based on their symptom burden trajectory

模型	C1	C2	C3
C1	0.937	0.035	0.028
C2	0.048	0.919	0.033
C3	0.029	0.023	0.948

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表 3 是否发生近期CCE腹膜透析初期患者一般资料比较

Table 3. Comparison of general characteristics in early-stage peritoneal dialysis patients with and without recent CCE

近期CCE	例数	年龄(x±s，岁)	性别(例)		腹膜透析病因(例)					CCI得分(例)			心脑血管疾病史(例)
近期CCE	例数	年龄(x±s，岁)	男性	女性	慢性肾小球肾炎	糖尿病肾病	高血压肾病	狼疮性肾炎		2~4分	5~6分	＞6分	心脑血管疾病史(例)
有	40	66.38±4.29	26	14	15	9	11	5		10	12	18	30
无	110	64.26±4.43	70	40	41	27	30	12		68	28	14	61
统计量		2.613^a	0.024^b		0.118^b					22.195^b			4.696^b
P值		0.010	0.878		0.990					＜0.001			0.030

近期CCE			例数		BUN (x±s, mmol/L)	Scr (x±s, μmol/L)	GFR[x±s, mL/ (min·1.73 m²)]	P^3- (x±s, mmol/L)	K⁺ (x±s, mmol/L)	Na⁺ (x±s, mmol/L)	症状负担轨迹(例)
近期CCE			例数		BUN (x±s, mmol/L)	Scr (x±s, μmol/L)	GFR[x±s, mL/ (min·1.73 m²)]	P^3- (x±s, mmol/L)	K⁺ (x±s, mmol/L)	Na⁺ (x±s, mmol/L)	C1组	C2组	C3组
有			40		20.69±6.34	856.24±136.37	11.03±1.89	1.56±0.22	4.25±0.39	140.32±21.34	6	16	18
无			110		21.43±6.08	818.95±129.45	10.68±1.78	1.52±0.23	4.16±0.37	143.26±20.96	36	52	22
统计量					0.652^a	1.538^a	1.048^a	0.953^a	1.299^a	0.756^a	10.510^b
P值					0.516	0.126	0.297	0.342	0.196	0.451	0.005
注：^a为t值，^b为χ²值。

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表 4 腹膜透析初期患者症状负担轨迹与近期CCE的关系

Table 4. Relationship between the symptom burden trajectory of patients in the early stage of peritoneal dialysis and recent CCE

症状负担轨迹	模型1		模型2		模型3
症状负担轨迹	OR(95%CI)	P值	OR(95%CI)	P值	OR(95%CI)	P值
C1组
C2组	1.022(0.229~4.561)	0.498	2.361(0.759~7.344)	0.316	2.405(0.884~6.543)	0.175
C3组	3.167(1.836~5.463)	0.040	4.008(2.210~7.269)	0.034	5.396(3.305~8.810)	0.029
趋势性检验P值		0.023		0.028		0.033
注：以C1组为参照。变量赋值如下，近期CCE，未发生=0，发生=1；年龄以实际值赋值；CCI得分2~4分=1，5~6分=2，＞6分=3；心脑血管疾病史，无=0，有=1。

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