甘肃地区单中心慢性肾脏病患者便秘患病率及危险因素分析

doi:10.3969/j.issn.1004-583X.2025.01.007

摘要/Abstract

摘要：

目的研究甘肃地区慢性肾脏病患者便秘的患病率并分析可能的危险因素。方法依据功能性便秘罗马Ⅲ标准,采用问卷星分两阶段(2022年7-8月、2023年1-2月)对兰州大学第二医院肾内科、血透中心患者发布便秘调查问卷。同时收集患者的人口统计学指标、透析相关指标、实验室化验检查并记录铁剂、磷结合剂等药物使用情况。结果共纳入18岁以上患者279例,其中血透患者191例,非透析患者88例。慢性肾脏病1~2期、3~4期和5期的便秘患病率分别为36.2%、45.8%和29.8%。单因素logistics回归显示,原发病为糖尿病肾病(OR=4.694, 95% CI 1.436~15.350,P=0.011)是非透析患者便秘的独立危险因素,甘油三酯水平高(OR=1.493,95% CI 1.082~2.060,P=0.015)是血透患者便秘的危险因素,各分期患者便秘的危险因素包括磷结合剂(OR=1.669,95% CI 1.001~2.784,P=0.049)、铁剂(OR=1.745, 95% CI 1.047~2.909,P=0.033)、较高的血糖(OR=1.070,95% CI 1.008~1.135,P=0.026)和甘油三酯(OR=1.254,95% CI 1.017~1.546,P=0.034)水平。多因素logistics回归显示性别为女性(OR=3.258, 95% CI 1.022~10.386,P=0.046)以及原发病为糖尿病肾病(OR=13.863,95% CI 1.815~105.901,P=0.011)是非透析患者便秘的独立危险因素,原发病为糖尿病肾病(OR=2.137,95% CI 1.015~4.499,P=0.046)是慢性肾脏病各期患者便秘的危险因素。结论原发病为糖尿病肾病是所有慢性肾脏病患者便秘的独立危险因素,此外性别为女性是非透析患者便秘的独立危险因素。

关键词: 肾功能不全, 慢性, 便秘, 患病率, 危险因素

Abstract:

Objective To investigate the prevalence of constipation among patients with chronic kidney disease (CKD) in Gansu province, and to analyze potential risk factors. Methods CKD patients in the Department of Nephrology and Dialysis Center & Clinical Medical School of the Second Hospital, Lanzhou University were surveyed by a constipation questionnaire developed according to the Rome III criteria during the two periods of July 2022 to August 2022, and January 2023 to February 2023 via the WJX platform. At the same time, demographics, hemodialysis-related data, laboratory parameters, and use of drugs such as iron and phosphorus binders were collected. Results Totally 279 adult CKD patients older than 18 years were enrolled, including 191 hemodialysis patients and 88 non-dialysis patients. The prevalence of constipation in CKD stage 1-2, 3-4, and 5 patients was 36.2%, 45.8%, and 29.8%, respectively. Univariate Logistic regression analysis showed that primary diabetic nephropathy (OR=4.694, 95% CI 1.436-15.350, P=0.011) was a significant risk factor for constipation in non-dialysis patients. High serum triglyceride (TG) (OR=1.493, 95% CI 1.082-2.060, P=0.015) was a risk factor for constipation in CKD patients receiving hemodialysis. The risk factors for constipation in CKD patients included the use of phosphorus binding agents (OR=1.669, 95% CI 1.001-2.784, P=0.049) and use of iron agents (OR=1.745, 95% CI 1.047-2.909, P=0.033), high serum glucose (Glu)(OR=1.070, 95% CI 1.008-1.135, P=0.026) and TG (OR=1.254, 95% CI 1.017-1.546, P=0.034). Multivariate Logistic regression showed that female (OR=3.258, 95% CI 1.022-10.386, P=0.046) and diabetic nephropathy (OR=13.863, 95% CI 1.815-105.901, P=0.011) were independent risk factors for constipation in non-dialysis patients. In addition, diabetic nephropathy (OR=2.137, 95% CI 1.015-4.499, P=0.046) was a risk factor for constipation in CKD patients. Conclusion Diabetic nephropathy is an independent risk factor for constipation in CKD patients. The female gender represents an independent risk factor for constipation in non-dialysis patients.

Key words: renal insufficiency, chronic, constipation, prevalence, risk factors

中图分类号:

R692.5

蒲茜, 成刚, 道杰草, 齐梓兆, 窦乐乐, 赵军芳, 张文君, 郭彩霞, 王莹莹. 甘肃地区单中心慢性肾脏病患者便秘患病率及危险因素分析[J]. 临床荟萃, 2025, 40(1): 44-53.

Pu Qian, Cheng Gang, Dao Jiecao, Qi Zizhao, Dou Lele, Zhao Junfang, Zhang Wenjun, Guo Caixia, Wang Yingying. Risk factors for constipation in patients with chronic kidney disease in Gansu province: a single-center study[J]. Clinical Focus, 2025, 40(1): 44-53.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2025.01.007

https://huicui.hebmu.edu.cn/CN/Y2025/V40/I1/44

图/表 8

图1 CKD患者便秘患病率

Fig. 1 Prevalence of constipation in CKD patients

图2 CKD不同分期的便秘患病率

Fig. 2 Prevalence of constipation in CKD patients at different stages

表1 CKD患者便秘组与非便秘组基本特征( n=279)

Tab. 1 Basic characteristics of CKD patients with and without constipation ( n=279)

因素	CKD 1~2期( $n$ =47)			CKD 3~4期( $n$ =24)			CKD 5期( $n$ =208)
因素	便秘( $n$ =17)	非便秘( $n$ =30)	$P$ 值	便秘( $n$ =11)	非便秘( $n$ =13)	$P$ 值	便秘( $n$ =62)	非便秘( $n$ =146)	$P$ 值
年龄(岁)	44.71±16.16	48.63±15.2	0.410	62.27±11.74	50.23±18.58	0.068	53.65±16.38	50.21±13.88	0.124
性别(%)
女	47.1	33.3	0.352	45.5	30.8	0.459	37.1	33.6	0.624
原发病(%)			0.558			0.044			0.701
不明	0.0	3.3		9.1	0.0		11.3	15.8
肾小球肾炎	11.8	23.3		9.1	15.4		12.9	14.4
糖尿病肾病	17.6	6.7		72.7	15.4		38.7	31.5
IgA肾病	5.9	6.7		0.0	15.4		1.6	4.1
肾病综合征	0.0	6.7		0.0	7.7		14.5	10.3
其他	64.7	53.3		9.1	46.2		21.0	24.0
BMI(kg/m²)	25.58±5.33	24.9±3.27	0.591	25.21±1.67	23.7±4.34	0.288	22.95±3.55	22.83±3.83	0.823
血压(mmHg)
SBP	127.65±21.45	134.7±26.74	0.357	146.27±23.72	140.38±23.71	0.551	145.45±19.04	142.84±21.13	0.404
DBP	78.18±9.84	86.2±16.46	0.074	83.36±13.78	88±15.63	0.453	82.1±16.05	81.82±14.78	0.902
CRP(mg/L)	1.97±2.37	4.67±6.75	0.054	1.32±1.47	4.69±6.43	0.104	7.53±8.4	7.01±6.31	0.628
IL-6(pg/ml)	12.87±7.81	14.9±10.22	0.484	14.81±7.45	23.84±42.72	0.497	18.01±8.02	21.6±30.72	0.366
PCT(ng/ml)	0.18±0.34	0.3±0.42	0.334	0.28±0.4	0.51±0.72	0.353	1.51±3.3	1.35±3.77	0.775
WBC(10⁹/L)	8.14±3.25	9.14±3.96	0.380	6.06±2.03	6.21±2.96	0.888	6.93±10.56	5.93±2.34	0.278
HGB(g/L)	140.06±17.12	142.17±20.44	0.721	121.36±24.62	113.92±31.15	0.529	101.08±29.53	100.14±20.43	0.793
PLT(10⁹/L)	196.82±68.27	218.3±58.09	0.259	193.18±84.26	178.77±67.7	0.647	160.25±73.83	166.75±75.82	0.570
CREA(μmol/L)	64.05±23.96	80.61±22.2	0.021	194.86±90.21	208.78±106.37	0.736	867.83±375.75	897.52±315	0.558
GLU(mmol/L)	7.03±3.23	5.97±2.49	0.213	9.22±7.37	6.22±2.58	0.184	8.11±5.26	7.01±3.8	0.141
ALB(g/L)	29.26±7.86	31.25±8.82	0.445	34.47±9.63	32.35±6.59	0.530	36.23±9.38	38.31±7.05	0.081
CHO(mmol/L)	6.08±1.94	5.81±2.08	0.668	4.91±1.35	5.14±2.39	0.777	3.53±1.3	3.44±1.11	0.605
TG(mmol/L)	2.72±2.25	2.33±1.09	0.429	2.22±0.96	2.42±1.28	0.668	1.93±1.09	1.61±0.98	0.042
K⁺(mmol/L)	3.86±0.56	3.86±0.48	0.992	4.03±0.64	3.98±0.36	0.796	4.73±0.74	4.78±0.74	0.660
Na⁺(mmol/L)	136.82±3.06	138.4±1.98	0.068	135.95±3.14	137.17±4.82	0.479	136.16±3.03	137.09±3.12	0.046
CO₂(mmol/L)	25.71±3.54	25.53±2.22	0.852	23.62±2.85	22.51±3.29	0.391	25.06±10.69	24.74±9.2	0.823
Ca²⁺(mmol/L)	2.09±0.18	2.14±0.18	0.391	2.17±0.26	2.1±0.19	0.483	2.17±0.34	2.34±1.64	0.409
P(mmol/L)	1.15±0.14	1.12±0.3	0.675	1.18±0.13	1.22±0.31	0.662	1.63±0.73	1.7±0.58	0.493
BUN(mmol/L)	6.35±1.76	8.46±6.87	0.223	14.56±5.55	12.36±7.77	0.442	24.41±8.23	23.99±5.7	0.674
PTH(pg/ml)	140.06±17.12	142.17±20.44	0.787	155.01±117.84	235.33±207.26	0.268	392.78±257.99	397.12±255.4	0.911

表1 CKD患者便秘组与非便秘组基本特征( n=279)

Tab. 1 Basic characteristics of CKD patients with and without constipation ( n=279)

因素	CKD 1~2期( $n$ =47)			CKD 3~4期( $n$ =24)			CKD 5期( $n$ =208)
因素	便秘( $n$ =17)	非便秘( $n$ =30)	$P$ 值	便秘( $n$ =11)	非便秘( $n$ =13)	$P$ 值	便秘( $n$ =62)	非便秘( $n$ =146)	$P$ 值
年龄(岁)	44.71±16.16	48.63±15.2	0.410	62.27±11.74	50.23±18.58	0.068	53.65±16.38	50.21±13.88	0.124
性别(%)
女	47.1	33.3	0.352	45.5	30.8	0.459	37.1	33.6	0.624
原发病(%)			0.558			0.044			0.701
不明	0.0	3.3		9.1	0.0		11.3	15.8
肾小球肾炎	11.8	23.3		9.1	15.4		12.9	14.4
糖尿病肾病	17.6	6.7		72.7	15.4		38.7	31.5
IgA肾病	5.9	6.7		0.0	15.4		1.6	4.1
肾病综合征	0.0	6.7		0.0	7.7		14.5	10.3
其他	64.7	53.3		9.1	46.2		21.0	24.0
BMI(kg/m²)	25.58±5.33	24.9±3.27	0.591	25.21±1.67	23.7±4.34	0.288	22.95±3.55	22.83±3.83	0.823
血压(mmHg)
SBP	127.65±21.45	134.7±26.74	0.357	146.27±23.72	140.38±23.71	0.551	145.45±19.04	142.84±21.13	0.404
DBP	78.18±9.84	86.2±16.46	0.074	83.36±13.78	88±15.63	0.453	82.1±16.05	81.82±14.78	0.902
CRP(mg/L)	1.97±2.37	4.67±6.75	0.054	1.32±1.47	4.69±6.43	0.104	7.53±8.4	7.01±6.31	0.628
IL-6(pg/ml)	12.87±7.81	14.9±10.22	0.484	14.81±7.45	23.84±42.72	0.497	18.01±8.02	21.6±30.72	0.366
PCT(ng/ml)	0.18±0.34	0.3±0.42	0.334	0.28±0.4	0.51±0.72	0.353	1.51±3.3	1.35±3.77	0.775
WBC(10⁹/L)	8.14±3.25	9.14±3.96	0.380	6.06±2.03	6.21±2.96	0.888	6.93±10.56	5.93±2.34	0.278
HGB(g/L)	140.06±17.12	142.17±20.44	0.721	121.36±24.62	113.92±31.15	0.529	101.08±29.53	100.14±20.43	0.793
PLT(10⁹/L)	196.82±68.27	218.3±58.09	0.259	193.18±84.26	178.77±67.7	0.647	160.25±73.83	166.75±75.82	0.570
CREA(μmol/L)	64.05±23.96	80.61±22.2	0.021	194.86±90.21	208.78±106.37	0.736	867.83±375.75	897.52±315	0.558
GLU(mmol/L)	7.03±3.23	5.97±2.49	0.213	9.22±7.37	6.22±2.58	0.184	8.11±5.26	7.01±3.8	0.141
ALB(g/L)	29.26±7.86	31.25±8.82	0.445	34.47±9.63	32.35±6.59	0.530	36.23±9.38	38.31±7.05	0.081
CHO(mmol/L)	6.08±1.94	5.81±2.08	0.668	4.91±1.35	5.14±2.39	0.777	3.53±1.3	3.44±1.11	0.605
TG(mmol/L)	2.72±2.25	2.33±1.09	0.429	2.22±0.96	2.42±1.28	0.668	1.93±1.09	1.61±0.98	0.042
K⁺(mmol/L)	3.86±0.56	3.86±0.48	0.992	4.03±0.64	3.98±0.36	0.796	4.73±0.74	4.78±0.74	0.660
Na⁺(mmol/L)	136.82±3.06	138.4±1.98	0.068	135.95±3.14	137.17±4.82	0.479	136.16±3.03	137.09±3.12	0.046
CO₂(mmol/L)	25.71±3.54	25.53±2.22	0.852	23.62±2.85	22.51±3.29	0.391	25.06±10.69	24.74±9.2	0.823
Ca²⁺(mmol/L)	2.09±0.18	2.14±0.18	0.391	2.17±0.26	2.1±0.19	0.483	2.17±0.34	2.34±1.64	0.409
P(mmol/L)	1.15±0.14	1.12±0.3	0.675	1.18±0.13	1.22±0.31	0.662	1.63±0.73	1.7±0.58	0.493
BUN(mmol/L)	6.35±1.76	8.46±6.87	0.223	14.56±5.55	12.36±7.77	0.442	24.41±8.23	23.99±5.7	0.674
PTH(pg/ml)	140.06±17.12	142.17±20.44	0.787	155.01±117.84	235.33±207.26	0.268	392.78±257.99	397.12±255.4	0.911

表2 自变量共线性分析

Tab. 2 Collinearity analysis of independent variables

因素	所有CKD患者		HD组		CKD非透析
因素	容差	VIF	容差	VIF	容差	VIF
透析模式	0.092	10.837
季节	0.192	5.204	0.316	3.169
超滤量			0.074	13.533
年龄	0.290	3.447	0.256	3.899	0.218	4.577
性别	0.290	3.443	0.325	3.078	0.147	6.797
原发病	0.215	4.656	0.155	6.447	0.427	2.344
铁剂使用	0.213	4.699	0.156	6.410	0.484	2.067
磷剂使用	0.711	1.407	0.669	1.495	0.554	1.805
BMI	0.026	38.780	0.022	45.331	0.018	54.618
CRP	0.482	2.074	0.374	2.677	0.582	1.718
IL-6	0.566	1.768	0.577	1.732	0.252	3.961
PCT	0.637	1.571	0.581	1.722	0.312	3.201
WBC	0.068	14.623	0.038	26.493	0.086	11.563
HGB	0.035	28.521	0.033	30.026	0.019	54.019
PLT	0.083	12.110	0.084	11.845	0.066	15.259
CREA	0.067	15.014	0.055	18.150	0.130	7.692
GLU	0.182	5.487	0.157	6.359	0.182	5.483
ALB	0.027	37.211	0.015	67.722	0.012	80.719
CHO	0.067	14.980	0.050	20.145	0.046	21.642
TG	0.192	5.220	0.145	6.914	0.167	5.977
K⁺	0.141	7.089	0.071	14.035	0.016	64.146
Na⁺	0.015	68.838	0.011	91.350	0.010	95.917
CO₂	0.035	28.392	0.041	24.217	0.009	105.720
Ca²⁺	0.068	14.622	0.074	13.519	0.003	338.749
P	0.065	15.489	0.064	15.509	0.030	33.644
BUN	0.061	16.496	0.035	28.425	0.101	9.902
PTH	0.258	3.873	0.247	4.049	0.196	5.111

表3 CKD透析前患者便秘危险因素分析

Tab. 3 Analysis of risk factors for constipation in per-dialysis patients with CKD

因素	单因素logistics回归			多因素logistics回归
因素	$O R$ 值	95% $C I$	$P$ 值	$O R$ 值	95% $C I$	$P$ 值
年龄
≥65岁	1.145	0.394~3.327	0.803	0.295	0.053~1.648	0.164
性别
女	1.863	0.763~4.547	0.172	3.258	1.022~10.386	0.046
原发病
不明	0.361	0.039~3.341	0.370	0.682	0.049~9.559	0.776
肾小球肾炎	0.722	0.165~3.156	0.665	0.735	0.136~3.969	0.721
糖尿病肾病	4.694	1.436~15.350	0.011	13.863	1.815~105.901	0.011
IgA肾病	0.433	0.046~4.125	0.467	0.671	0.059~7.625	0.748
肾病综合征	1.083	0.174~6.753	0.932	6.315	0.502~79.387	0.154
其他
磷结合剂	0.429	0.128~1.437	0.170	0.675	0.132~3.463	0.638
铁剂	0.613	0.196~1.912	0.399	0.295	0.053~1.648	0.164
BMI	1.041	0.936~1.158	0.455
CRP	0.999	0.943~1.058	0.969	0.966	0.894~1.044	0.386
IL-6	0.995	0.969~1.021	0.686	1.011	0.970~1.054	0.605
PCT	0.662	0.244~1.796	0.418	0.756	0.155~3.681	0.729
WBC	0.970	0.856~1.100	0.636
HGB	1.002	0.988~1.017	0.756
PLT	0.998	0.991~1.004	0.464
CREA	0.999	0.997~1.001	0.413	0.999	0.996~1.003	0.644
Glu	1.120	0.984~1.274	0.086	1.026	0.868~1.211	0.767
ALB	0.982	0.930~1.037	0.513
CHO	1.025	0.823~1.276	0.828
TG	1.054	0.787~1.412	0.724	0.981	0.694~1.387	0.912
K⁺	0.708	0.339~1.480	0.359
Na⁺	0.852	0.727~0.999	0.049
CO₂	1.065	0.936~1.212	0.339
Ca²⁺	1.633	0.200~13.308	0.647
P	0.602	0.157~2.312	0.460
BUN	0.993	0.946~1.042	0.772	1.005	0.914~1.105	0.923
PTH	0.999	0.997~1.001	0.288	0.999	0.996~1.002	0.466

表3 CKD透析前患者便秘危险因素分析

Tab. 3 Analysis of risk factors for constipation in per-dialysis patients with CKD

因素	单因素logistics回归			多因素logistics回归
因素	$O R$ 值	95% $C I$	$P$ 值	$O R$ 值	95% $C I$	$P$ 值
年龄
≥65岁	1.145	0.394~3.327	0.803	0.295	0.053~1.648	0.164
性别
女	1.863	0.763~4.547	0.172	3.258	1.022~10.386	0.046
原发病
不明	0.361	0.039~3.341	0.370	0.682	0.049~9.559	0.776
肾小球肾炎	0.722	0.165~3.156	0.665	0.735	0.136~3.969	0.721
糖尿病肾病	4.694	1.436~15.350	0.011	13.863	1.815~105.901	0.011
IgA肾病	0.433	0.046~4.125	0.467	0.671	0.059~7.625	0.748
肾病综合征	1.083	0.174~6.753	0.932	6.315	0.502~79.387	0.154
其他
磷结合剂	0.429	0.128~1.437	0.170	0.675	0.132~3.463	0.638
铁剂	0.613	0.196~1.912	0.399	0.295	0.053~1.648	0.164
BMI	1.041	0.936~1.158	0.455
CRP	0.999	0.943~1.058	0.969	0.966	0.894~1.044	0.386
IL-6	0.995	0.969~1.021	0.686	1.011	0.970~1.054	0.605
PCT	0.662	0.244~1.796	0.418	0.756	0.155~3.681	0.729
WBC	0.970	0.856~1.100	0.636
HGB	1.002	0.988~1.017	0.756
PLT	0.998	0.991~1.004	0.464
CREA	0.999	0.997~1.001	0.413	0.999	0.996~1.003	0.644
Glu	1.120	0.984~1.274	0.086	1.026	0.868~1.211	0.767
ALB	0.982	0.930~1.037	0.513
CHO	1.025	0.823~1.276	0.828
TG	1.054	0.787~1.412	0.724	0.981	0.694~1.387	0.912
K⁺	0.708	0.339~1.480	0.359
Na⁺	0.852	0.727~0.999	0.049
CO₂	1.065	0.936~1.212	0.339
Ca²⁺	1.633	0.200~13.308	0.647
P	0.602	0.157~2.312	0.460
BUN	0.993	0.946~1.042	0.772	1.005	0.914~1.105	0.923
PTH	0.999	0.997~1.001	0.288	0.999	0.996~1.002	0.466

图3 HD不同超滤量的便秘患病率

Fig. 3 Prevalence of constipation by different ultrafiltration volumes in HD

表4 HD患者便秘危险因素分析

Tab. 4 Risk factors for constipation in patients with HD

因素	单因素logistics回归			多因素logistics回归
因素	$O R$ 值	95% $C I$	$P$ 值	$O R$ 值	95% $C I$	$P$ 值
年龄
≥65岁	1.309	0.626~2.740	0.474	1.314	0.591~2.924	0.503
季节
夏秋	0.797	0.430~1.479	0.473	0.921	0.450~1.888	0.823
性别
女	1.110	0.582~2.115	0.751	1.355	0.665~2.762	0.403
原发病
不明	0.927	0.313~2.750	0.892	0.959	0.294~3.135	0.945
肾小球肾炎	0.908	0.312~2.571	0.856	1.034	0.341~3.130	0.953
糖尿病肾病	1.192	0.522~2.722	0.676	1.254	0.507~3.104	0.624
IgA肾病	0.477	0.051~4.491	0.518	0.428	0.043~4.307	0.472
肾病综合征	1.192	0.391~3.635	0.757	1.074	0.328~3.513	0.906
其他
磷结合剂
使用	0.657	0.310~1.392	0.273	0.770	0.330~1.796	0.545
铁剂
使用	0.520	0.249~1.085	0.082	0.614	0.276~1.367	0.233
超滤量
>3 000 ml	0.731	0.166~3.217	0.678
2 000~3 000 ml	1.073	0.244~4.712	0.925
1 000~2 000 ml	0.824	0.180~3.763	0.807
<1 000 ml
BMI	1.019	0.935~1.111	0.667
CRP	0.977	0.927~1.030	0.387	0.980	0.927~1.035	0.468
IL-6	0.995	0.894~1.020	0.168	0.979	0.915~1.049	0.549
PCT	1.008	0.932~1.090	0.845	1.010	0.928~1.099	0.816
WBC	1.023	0.972~1.076	0.387
HGB	1.003	0.990~1.016	0.662
PLT	0.999	0.995~1.004	0.744
CREA	1.000	0.999~1.001	0.384
GLU	1.059	0.990~1.133	0.098	1.025	0.948~1.108	0.536
ALB	0.971	0.935~1.007	0.116
CHO	1.131	0.853~1.500	0.392
TG	1.493	1.082~2.060	0.015	1.395	0.973~2.000	0.070
K⁺	1.036	0.943~1.137	0.463
Na⁺	0.992	0.977~1.007	0.294
CO₂	1.002	0.972~1.033	0.898
Ca²⁺	0.547	0.197~1.518	0.247
P	0.851	0.524~1.383	0.515
BUN	0.998	0.950~1.049	0.947
PTH	1.000	0.999~1.001	0.968

表4 HD患者便秘危险因素分析

Tab. 4 Risk factors for constipation in patients with HD

因素	单因素logistics回归			多因素logistics回归
因素	$O R$ 值	95% $C I$	$P$ 值	$O R$ 值	95% $C I$	$P$ 值
年龄
≥65岁	1.309	0.626~2.740	0.474	1.314	0.591~2.924	0.503
季节
夏秋	0.797	0.430~1.479	0.473	0.921	0.450~1.888	0.823
性别
女	1.110	0.582~2.115	0.751	1.355	0.665~2.762	0.403
原发病
不明	0.927	0.313~2.750	0.892	0.959	0.294~3.135	0.945
肾小球肾炎	0.908	0.312~2.571	0.856	1.034	0.341~3.130	0.953
糖尿病肾病	1.192	0.522~2.722	0.676	1.254	0.507~3.104	0.624
IgA肾病	0.477	0.051~4.491	0.518	0.428	0.043~4.307	0.472
肾病综合征	1.192	0.391~3.635	0.757	1.074	0.328~3.513	0.906
其他
磷结合剂
使用	0.657	0.310~1.392	0.273	0.770	0.330~1.796	0.545
铁剂
使用	0.520	0.249~1.085	0.082	0.614	0.276~1.367	0.233
超滤量
>3 000 ml	0.731	0.166~3.217	0.678
2 000~3 000 ml	1.073	0.244~4.712	0.925
1 000~2 000 ml	0.824	0.180~3.763	0.807
<1 000 ml
BMI	1.019	0.935~1.111	0.667
CRP	0.977	0.927~1.030	0.387	0.980	0.927~1.035	0.468
IL-6	0.995	0.894~1.020	0.168	0.979	0.915~1.049	0.549
PCT	1.008	0.932~1.090	0.845	1.010	0.928~1.099	0.816
WBC	1.023	0.972~1.076	0.387
HGB	1.003	0.990~1.016	0.662
PLT	0.999	0.995~1.004	0.744
CREA	1.000	0.999~1.001	0.384
GLU	1.059	0.990~1.133	0.098	1.025	0.948~1.108	0.536
ALB	0.971	0.935~1.007	0.116
CHO	1.131	0.853~1.500	0.392
TG	1.493	1.082~2.060	0.015	1.395	0.973~2.000	0.070
K⁺	1.036	0.943~1.137	0.463
Na⁺	0.992	0.977~1.007	0.294
CO₂	1.002	0.972~1.033	0.898
Ca²⁺	0.547	0.197~1.518	0.247
P	0.851	0.524~1.383	0.515
BUN	0.998	0.950~1.049	0.947
PTH	1.000	0.999~1.001	0.968

表5 所有CKD患者便秘危险因素分析

Tab. 5 Constipation risk factor analysis in all CKD patients

因素	单因素logistics回归			多因素logistics回归
因素	$O R$ 值	95% $C I$	$P$ 值	$O R$ 值	95% $C I$	$P$ 值
年龄
≥65岁	0.800	0.436~1.467	0.470	1.062	0.549~2.057	0.858
季节
夏秋	0.739	0.435~1.255	0.263	0.924	0.489~1.745	0.808
性别
女	1.333	0.794~2.240	0.277	1.665	0.944~2.937	0.078
原发病
不明	0.760	0.300~1.922	0.562	1.026	0.378~2.784	0.960
肾小球肾炎	0.836	0.362~1.928	0.674	1.098	0.453~2.663	0.836
糖尿病肾病	1.596	0.843~3.022	0.151	2.140	1.016~4.511	0.045
IgA肾病	0.456	0.093~2.235	0.333	0.529	0.103~2.710	0.445
肾病综合征	1.140	0.451~2.884	0.782	1.634	0.614~4.348	0.325
其他
磷结合剂	1.669	1.001~2.784	0.049	0.744	0.377~1.468	0.393
铁剂	1.745	1.047~2.909	0.033	0.660	0.345~1.266	0.211
HD	0.763	0.448~1.300	0.320
BMI	1.034	0.970~1.104	0.304
CRP	0.983	0.945~1.022	0.383	0.987	0.947~1.028	0.522
IL-6	0.985	0.958~1.013	0.285	0.992	0.972~1.012	0.406
PCT	0.998	0.921~1.082	0.965	1.026	0.947~1.111	0.528
WBC	1.018	0.974~1.064	0.435
HGB	1.004	0.995~1.013	0.375
PLT	0.999	0.996~1.003	0.633
CREA	1.000	0.999~1.000	0.128
GLU	1.070	1.008~1.135	0.026	1.045	0.973~1.121	0.225
ALB	0.972	0.944~1.001	0.058
CHO	1.087	0.940~1.257	0.259
TG	1.254	1.017~1.546	0.034	1.128	0.890~1.428	0.319
K⁺	1.026	0.968~1.089	0.386	1.034	0.909~1.176	0.613
Na⁺	0.989	0.975~1.003	0.115
CO₂	1.004	0.976~1.033	0.782
Ca²⁺	0.630	0.259~1.530	0.308
P	0.778	0.506~1.197	0.253
BUN	0.989	0.962~1.017	0.424
PTH	1.000	0.999~1.001	0.486

表5 所有CKD患者便秘危险因素分析

Tab. 5 Constipation risk factor analysis in all CKD patients

因素	单因素logistics回归			多因素logistics回归
因素	$O R$ 值	95% $C I$	$P$ 值	$O R$ 值	95% $C I$	$P$ 值
年龄
≥65岁	0.800	0.436~1.467	0.470	1.062	0.549~2.057	0.858
季节
夏秋	0.739	0.435~1.255	0.263	0.924	0.489~1.745	0.808
性别
女	1.333	0.794~2.240	0.277	1.665	0.944~2.937	0.078
原发病
不明	0.760	0.300~1.922	0.562	1.026	0.378~2.784	0.960
肾小球肾炎	0.836	0.362~1.928	0.674	1.098	0.453~2.663	0.836
糖尿病肾病	1.596	0.843~3.022	0.151	2.140	1.016~4.511	0.045
IgA肾病	0.456	0.093~2.235	0.333	0.529	0.103~2.710	0.445
肾病综合征	1.140	0.451~2.884	0.782	1.634	0.614~4.348	0.325
其他
磷结合剂	1.669	1.001~2.784	0.049	0.744	0.377~1.468	0.393
铁剂	1.745	1.047~2.909	0.033	0.660	0.345~1.266	0.211
HD	0.763	0.448~1.300	0.320
BMI	1.034	0.970~1.104	0.304
CRP	0.983	0.945~1.022	0.383	0.987	0.947~1.028	0.522
IL-6	0.985	0.958~1.013	0.285	0.992	0.972~1.012	0.406
PCT	0.998	0.921~1.082	0.965	1.026	0.947~1.111	0.528
WBC	1.018	0.974~1.064	0.435
HGB	1.004	0.995~1.013	0.375
PLT	0.999	0.996~1.003	0.633
CREA	1.000	0.999~1.000	0.128
GLU	1.070	1.008~1.135	0.026	1.045	0.973~1.121	0.225
ALB	0.972	0.944~1.001	0.058
CHO	1.087	0.940~1.257	0.259
TG	1.254	1.017~1.546	0.034	1.128	0.890~1.428	0.319
K⁺	1.026	0.968~1.089	0.386	1.034	0.909~1.176	0.613
Na⁺	0.989	0.975~1.003	0.115
CO₂	1.004	0.976~1.033	0.782
Ca²⁺	0.630	0.259~1.530	0.308
P	0.778	0.506~1.197	0.253
BUN	0.989	0.962~1.017	0.424
PTH	1.000	0.999~1.001	0.486

参考文献 33

[1]	Lv JC, Zhang LX. Prevalence and disease burden of chronic kidney disease[J]. Adv Exp Med Biol, 2019, 1165: 3-15.
[2]	白雪莲, 张佳宜, 项国梁, 等. 中国成人慢性肾脏病患病率的meta分析[J]. 中国医药科学, 2022, 12(9): 49-53.
[3]	Sumida K, Molnar MZ, Potukuchi PK, et al. Constipation and incident CKD[J]. J Am Soc Nephrol, 2017, 28(4): 1248-1258. doi: 10.1681/ASN.2016060656 pmid: 28122944
[4]	Ramos CI, Armani RG, Canziani ME, et al. Bowel habits and the association with uremic toxins in non-dialysis-dependent chronic kidney disease patients[J]. J Ren Nutr, 2020, 30(1): 31-35.
[5]	Lee A, Lambert K, Byrne P, et al. Prevalence of constipation in patients with advanced kidney disease[J]. J Ren Care, 2016, 42(3): 144-149.
[6]	Kosmadakis G, Albaret J, Da Costa Correia E, et al. Constipation in peritoneal dialysis patients[J]. Perit Dial Int, 2019, 39(5): 399-404.
[7]	Sumida K, Kovesdy CP. The gut-kidney-heart axis in chronic kidney disease[J]. Physiol Int, 2019, 106(3): 195-206. doi: 10.1556/2060.106.2019.19 pmid: 31560235
[8]	Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders[J]. Gastroenterology, 2006, 130(5): 1480-1491. doi: 10.1053/j.gastro.2005.11.061 pmid: 16678561
[9]	Senanayake S, Gunawardena N, Palihawadana P, et al. Symptom burden in chronic kidney disease; a population based cross sectional study[J]. BMC Nephrol, 2017, 18(1): 228. doi: 10.1186/s12882-017-0638-y pmid: 28693434
[10]	周菲. Logistic回归多重共线性的诊断与改进及其在医学中的应用[D]. 兰州: 兰州大学, 2011.
[11]	Ruszkowski J, Heleniak Z, Król E, et al. Constipation and the quality of life in conservatively treated chronic kidney disease patients: A cross-sectional study[J]. Int J Med Sci, 2020, 17(18): 2954-2963. doi: 10.7150/ijms.49648 pmid: 33173416
[12]	Zhang L, Tang F, Wang F, et al. The prevalence of constipation in end-stage kidney disease patients: A cross-sectional observation study[J]. Medicine (Baltimore), 2022, 101(43): e31552.
[13]	Chen Z, Peng Y, Shi Q, et al. Prevalence and risk factors of functional constipation according to the rome criteria in China: A systematic review and meta-analysis[J]. Front Med (Lausanne), 2022, 9: 815156.
[14]	Ikee R, Toyoyama T, Endo T, et al. Clinical factors associated with constipation in hemodialysis patients[J]. Int Urol Nephrol, 2016, 48(10): 1741-1742. doi: 10.1007/s11255-016-1363-3 pmid: 27379624
[15]	Yasuda G, Shibata K, Takizawa T, et al. Prevalence of constipation in continuous ambulatory peritoneal dialysis patients and comparison with hemodialysis patients[J]. Am J Kidney Dis, 2002, 39(6): 1292-1299. pmid: 12046044
[16]	Matsuyama M, Hirai K, Nonaka H, et al. Effects of elobixibat on constipation and lipid metabolism in patients with moderate to end-stage chronic kidney disease[J]. Front Med (Lausanne), 2022, 8:780127.
[17]	唐亚, 张文君, 李静晶, 等. 老年终末期肾病患者血液透析质量及影响因素分析[J]. 中国血液净化, 2021, 20(1): 11-15.
[18]	Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy[J]. Nat Rev Dis Primers, 2019, 5(1):42. doi: 10.1038/s41572-019-0097-9 pmid: 31197183
[19]	Bharucha AE, Wald A. Chronic constipation[J]. Mayo Clin Proc, 2019, 94(11): 2340-2357.
[20]	Hu W, Smith TH, Grider JR, et al. Morphine decreases enteric neuron excitability via inhibition of sodium channels[J]. PLoS One, 2012, 7(9) :e45251.
[21]	Barberio B, Judge C, Savarino EV, et al. Global prevalence of functional constipation according to the Rome criteria: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2021, 6(8): 638-648.
[22]	Guarino M, Cheng L, Cicala M, et al. Progesterone receptors and serotonin levels in colon epithelial cells from females with slow transit constipation[J]. Neurogastroenterol Motil, 2011, 23(6): 575-e210.
[23]	Setyapranata S, Holt SG. The gut in older patients on peritoneal dialysis[J]. Perit Dial Int, 2015, 35(6): 650-654.
[24]	Wu MJ, Chang CS, Cheng CH, et al. Colonic transit time in long-term dialysis patients[J]. Am J Kidney Dis, 2004, 44(2): 322-327.
[25]	Vaziri ND, Wong J, Pahl M, et al. Chronic kidney disease alters intestinal microbial flora[J]. Kidney Int, 2013, 83(2): 308-315. doi: 10.1038/ki.2012.345 pmid: 22992469
[26]	Zhao Y, Yu YB. Intestinal microbiota and chronic constipation[J]. Springerplus, 2016, 5(1):1130. doi: 10.1186/s40064-016-2821-1 pmid: 27478747
[27]	Sumida K, Lau WL, Kovesdy CP, et al. Microbiome modulation as a novel therapeutic approach in chronic kidney disease[J]. Curr Opin Nephrol Hypertens, 2021, 30(1): 75-84.
[28]	Ramezani A, Massy ZA, Meijers B, et al. Role of the gut microbiome in uremia: A potential therapeutic target[J]. Am J Kidney Dis, 2016, 67(3):483-98. doi: 10.1053/j.ajkd.2015.09.027 pmid: 26590448
[29]	Sutton D, Dumbleton S, Allaway C. Can increased dietary fibre reduce laxative requirement in peritoneal dialysis patients?[J]. J Ren Care, 2007, 33(4): 174-178.
[30]	Zhao X, Meng J, Dai J, et al. Effect of biofeedback combined with high-quality nursing in treatment of functional constipation[J]. World J Clin Cases, 2021, 9(4): 784-791. doi: 10.12998/wjcc.v9.i4.784 pmid: 33585624
[31]	Gao R, Tao Y, Zhou C, et al. Exercise therapy in patients with constipation: A systematic review and meta-analysis of randomized controlled trials[J]. Scand J Gastroenterol, 2019, 54(2): 169-177.
[32]	Xu Y, Li X, Xia F, et al. Efficacy of a modified training program of adaptive biofeedback therapy for dyssynergic defecation in patients with chronic constipation[J]. Dig Dis Sci, 2021, 67(4): 1320-1327.
[33]	Rao SSC, Valestin JA, Xiang X, et al. Home-based versus office-based biofeedback therapy for constipation with dyssynergic defecation: A randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2018, 3(11): 768-777.