改良腹膜平衡试验在腹膜透析患者中的应用  

Practical application of modified peritoneal equilibrium test in peritoneal dialysis patients

作　　者：方炜[1] 钱家麒[1] 林爱武[1] 顾爱萍[1] 张凤棣[1] 

机构地区：[1]上海第二医科大学附属仁济医院肾脏科,200001

出　　处：《中华肾脏病杂志》2005年第12期728-731,共4页Chinese Journal of Nephrology

基　　金：国家自然科学基金资助项目(39870903);上海市教育委员会资助基金(98QB65)

摘　　要：目的 观察改良腹膜平衡试验(改良PET)在腹膜透析(腹透)患者中的应用,初 步建立改良PET转运参数的参考值,探讨其评估腹膜溶质转运特性的准确性及临床意义。方法 97例腹透患者用高渗腹透液(4．25％葡萄糖)进行改良PET,分别测定4 h透析液肌酐与血肌酐 比值(4h D／Pcr)、计算物质转运面积系数(MTAC)、1 h透析液钠与血钠比值(1h D／PNa+)及记录 净超率量(nUF)。其中有14例患者在1个月内曾行标准腹膜平衡试验(标准PET),其结果与改 良PET进行自身比较。所有患者在研究时及研究前1个月内均无腹膜炎。结果 97例腹透患 者中有90例nUF大于400 ml,这些患者的转运参数经正态分布校正后建立了改良PET的参考 值。改良PET的4 hD／Pcr为0．70±0．15,标准PET4 hD／Pcr为0．68±0．13,两者非常接近,差异 无统计学意义。两种PET对患者腹膜转运特性分型结果相似。7例nUF小于400 ml的患者中有 5例有效腹膜表面积增大;2例存在水通道介导的水转运障碍,其中1例同时存在有效腹膜表面 积增大,还有1例患者改良PET转运参数在正常范围内。结论 与标准PET相比,用高渗腹透 液进行改良PET能够准确地评估腹膜小分子溶质转运特性,此外还能提供更多更敏感的液体转 运信息,为临床诊断超滤衰竭,以及进一步鉴别其原因提供了有力的手段。Objectives To investigate the practical application of modified peritoneal equilibration test （modified PET） employing 4.25% glucose exchange in peritoneal dialysis patients and to assess the reference values and clinical significance of the test. Methods Modified PETs were performed in 97 patients without peritonitis for at least 4 weeks. Mass transfer area coefficient （MTAC） was calculated according to the Garred model. Creatinine D/P concentration ratio at 4 hr （4 h D/Per）, sodium D/P concentration ratio at 1 hr （1 h D/PNa·） and net ultrafltration （nUF） were also assessed. Ultra-filtration 〈 400 ml was defned as ultrafiltration failure （UFF）. Among these patients, 14 were also performed standard PETs using 2.5% glucose dialysate within 1 month . The results from standard and modified PET were compared. Results The data of 90 patients without UFF were available to establish reference values. 4 h D/Per of modified PET was very similar to that of standard PET （0.70±0.15 vs. 0.68±0.13 ,P〉 0.05）. 4 h D/Per and MTACcr of modified PET were significantly correlated with 4h D/Per of standard PET （P 〈 0.01 ）. Patient transport category was minimally influenced by dialysate tonicity. Causes of UFF were analyzed in 9 patients with nUF 〈 400 ml： high MTAC in 5 patients, reflecting a large vascular surface area; absent of sodium sieving in 2 patients, representing aquaporin-1 deficiency. One patient demonstrated both causes for UFF, and 1 patient had normal modified PET results. Conclusions Modified PET can evaluate the peritoneal solute transport status accurately. In addition to provide information of small solute transport, modified PET allows confirming UFF diagnosis and helps to identify its causes.

关 键 词：腹膜透析 腹膜平衡试验 超滤衰竭 

分 类 号：R459.5[医药卫生—治疗学] R457.1[医药卫生—临床医学]