急性腹透相关性腹膜炎患者超滤和溶质转运的变化  

Changes of the Peritoneal Membrane Ultrafiltration and Solute Transport Function after Peritonitis Episodes in CAPD Patients

作　　者：罗琼[1] 王青[1] 姜蕾[1] 聂李平[1] 侯霜[1] 郑磊[1] 陈丽[1] 廖玉梅[1] 高敏[1] 

机构地区：[1]北京大学深圳医院肾内科,深圳518036

出　　处：《中国中西医结合肾病杂志》2009年第9期791-793,共3页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：深圳市科技局基金资助项目(No.200602023)

摘　　要：目的:研究持续非卧床腹膜透析(CAPD)患者发生急性腹透相关性腹膜炎时腹膜超滤功能、腹膜对小分子物质转运的变化,以及急性腹膜炎对患者血清白蛋白的影响。方法:对2006年1月～2008年3月期间因腹透相关性腹膜炎住院的22例CAPD患者(男12例,女10例)进行研究,收集腹膜炎发生后第1、3、6、9、12天的血和腹透液标本,分别检测血和腹透液常规及肌酐、糖、白蛋白、Na+、K+。同时记录每天腹透超滤量,并查看患者腹膜炎发生前最后一次的腹膜平衡试验(PET)结果和腹膜炎发生前2周每日超滤量并计算其均值,分别作为腹膜炎发生后腹膜对肌酐转运及腹膜超滤情况的基线对照组。腹膜溶质转运的计算通过同一时间点该溶质腹透液与血浆的比值(D/P)测得。结果:与腹膜炎发生前腹透超滤量相比,腹膜炎发生后第1、3天超滤量明显减少,呈负超滤(P<0.01);腹膜炎发生后各时间点肌酐D/P值均较腹膜炎发生前肌酐D/P值明显升高(P<0.05);腹膜炎发生后第3、6、9、12天血清白蛋白水平明显低于腹膜炎发生第1天(P<0.05)。结论:CAPD合并急性腹膜炎时腹膜超滤功能降低,尤以腹膜炎早期更明显;急性腹膜炎导致腹膜对肌酐的转运增加及患者的血清白蛋白水平降低。Objective： To assess changes in the peritoneal membrane solute transport, ultrafiltration （UF） function and the serum albumin after peritonitis episodes in patients undergoing continuous ambulatory peritoneal dialysis （CAPD）. Methods： From Jan. 2006 to Mar. 2008, CAPD patients who had peritonitis episodes were enrolled. We measured plasma and dialysate creatinine （Cr）, albumin （Alb）, glucose （Gtu）, natrium （Na） and potassium （K） levels at 1,3,6,9,12 days after acute peritonitis episodes. In addition, the dialysate- to- plasma ratio of Cr （D/PCr）, Na （D/P Na）, K （D/P K） and the drained ultrafiltration （UF） volume at 1,3,6,9,12 days. We used the last peritoneal equilibration test （PET） and the average two weeks UF volume before peritonitis episodes as the baseline, and the results were analyzed and compared. Results： Totally 22 patients were enrolled in the peritonitis group, including 12 males and 10 females. The baseline and 1,3,6,9,12 days of acute peritonitis episodes of D/PCr （0. 670 ± 0. 076 vs 0. 799 ± 0. 229,0. 977 ± 0. 175,0. 915± 0. 144,0. 916 ± 0. 520,0. 934± 0. 066, P 〈 0.05 ）, showed significant changes, The baseline UF volume and 1,3 days of acute peritonitis episodes [ （628.0 ± 365.3 vs - 425.4 ±1 181.8, - 274.5±614.2）ml, P〈 0.01 ] showed very significant change. Serum albumin had a decrease in 3,6,9, 12 days than 1 day of peritonitis episodes （ P 〈 0.05）. Conclusion：Acute peritonitis episodes affect the peritoneal membrane solute transport function in CAPD patients, mainly with a decrease of ultrafiltration volume and an increase of creatinine transport. Acute peritonitis patients had a decrease of serum albumin.

关 键 词：腹膜炎 超滤 溶质转运 肌肝 白蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]