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目的:探讨改良查尔森合并症指数（modified Charlson comorbidity index，mCCI）联合血清白蛋白（albumin，Alb）水平对腹膜透析（peritoneal dialysis，PD）患者远期预后的预测价值。方法:采用回顾性队列研究分析，纳入2007年1月1日至2015年6月30日在南京鼓楼医院开始PD的患者。收集患者开始透析时的性别、年龄、基础疾病、实验室检查指标、透析充分性指标和预后等临床资料，计算开始PD时的mCCI。以PD透析龄是否超过5年作为评价预后的指标，将患者分为透析龄≥5年组和透析龄<5年组，分析并比较两组患者的临床资料，构建Cox回归模型分析PD患者全因死亡的影响因素，采用多因素Logistic回归模型及受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）分析mCCI及血清Alb水平对患者能否维持长期PD治疗的预测价值。结果:共183例符合条件的患者被纳入最终分析，男性106例（57.9%），女性77例（42.1%）；年龄（53.35±16.50）岁；合并高血压162例（88.5%），合并糖尿病55例（30.1%）；其中透析龄≥5年组97例，透析龄<5年组86例；总体5年技术生存率为65.1%。PD开始时，与透析龄≥5年组相比，透析龄<5年组患者年龄更大，mCCI更高，血清白蛋白水平更低，C反应蛋白（CRP）水平更高（均n P0.05）。多因素Logistic回归分析显示，年龄增加（n OR=1.022，95%n CI 1.000~1.043，n P=0.046）、mCCI增加（n OR=1.620，95%n CI 1.300~2.018，n P<0.001）、血清Alb水平下降（n OR=0.807，95%n CI 0.730~0.893，n P<0.001）是PD患者透析龄<5年的独立影响因素。ROC曲线分析显示，mCCI、血清Alb水平及两者联合预测透析龄<5年的曲线下面积（n AUC）分别分0.647（95%n CI 0.568~0.727）、0.655（95%n CI 0.577~0.734）和0.767（95%n CI 0.700~0.835），以两者联合预测预后的n AUC值最大。多因素Cox回归分析结果显示，年龄增加（n HR=1.073，95%n CI 1.046~1.100，n P<0.001）、mCCI增加（n HR=1.198，95%n CI 1.044~1.375，n P=0.010）、血清Alb水平下降（n HR=0.904，95%n CI 0.843~0.969，n P=0.004）是PD患者全因死亡的独立影响因素。n 结论:年龄大、高mCCI、低血清Alb水平是PD患者透析龄<5年和全因死亡的独立影响因素。mCCI联合血清Alb水平可以提高预测PD患者能否维持长期透析的准确性。“,”Objective:To assess the prognostic value of modified Charlson comorbidity index (mCCI) combined with serum albumin for long-term prognosis in peritoneal dialysis (PD) patients.Methods:From January 1, 2007 to June 30, 2015, patients who started PD in Nanjing Drum Tower Hospital were enrolled in this retrospective cohort study. Clinical data including gender, age, underlying diseases, laboratory examination and prognosis were collected. The mCCI at the beginning of PD was calculated. Whether the duration of PD exceeded 5 years was used as an indicator to evaluate the prognosis. The patients were divided into≥5 years group and<5 years group according to the duration of PD, and the data were compared between the two groups. Cox regression model was constructed to analyze the influencing factors of all-cause death in PD patients. Multivariate logistic regression model and receiver operating characteristic (ROC) curve were used to analyze the predictive value of mCCI and serum albumin levels on whether patients could maintain long-term PD.Results:Of the 183 patients included [males 106(57.9%), females 77(42.1%); (53.35±16.50) years old; 162 cases (88.5%) with hypertension, 55 cases (30.1%) with diabetes], 97 cases had PD duration for ≥5 years and 86 cases less than 5 years. The overall 5-year technical survival rate was 65.1%. At the beginning of PD, compared with the dialysis age≥5 years group, the patients in the dialysis age less than 5 years group had older age, higher mCCI, lower serum albumin level, and higher C-reactive protein (CRP) level (all n P0.05). Multivariate logistic regression analysis showed that increased age (n OR=1.022, 95%n CI 1.000-1.043, n P=0.046), increased mCCI (n OR=1.620, 95%n CI 1.300-2.018, n P<0.001) and decreased serum albumin (n OR=0.807, 95%n CI 0.730-0.893, n P<0.001) were independent predictors for the duration of PD<5 years. ROC curve analysis showed that the area under ROC curves (n AUC) of mCCI, serum albumin level and combined prediction probability of the two for the duration of PD<5 years were 0.647(95%n CI 0.568-0.727), 0.655(95%n CI 0.577-0.734), and 0.767(95%n CI 0.700-0.835), respectively, indicating that the accuracy of combined parameters to predict survival outcome was higher than that of any single parameter. Multivariate Cox analysis showed that increased age (n HR=1.073, 95%n CI 1.046-1.100, n P<0.001), increased mCCI (n HR=1.198, 95%n CI 1.044-1.375, n P=0.010) and decreased serum albumin (n HR=0.904, 95%n CI 0.843-0.969, n P=0.004) were independent influencing factors for all-cause death in PD patients.n Conclusions:Old age, high mCCI and low serum albumin level are influencing factors for dialysis age<5 years and all-cause death in PD patients. mCCI combined with serum albumin level can improve the accuracy of predicting the long-term dialysis in PD patients.