不同腹膜通透性对患者营养及心脏结构的影响  

Influence of Different Peritoneal Permeabilities on Nutrition and Heart Structure of the Patients

作　　者：毕学青[1] 魏芳[1] 于海波[1] 王喆[1] 姜埃利[1] 

机构地区：[1]天津医科大学第二医院血液净化科,天津300211

出　　处：《河北北方学院学报（医学版）》2010年第1期10-13,共4页Journal of Hebei North University:Medical Edition

摘　　要：目的：探讨持续不卧床腹膜透析（CAPD）患者不同腹膜转运功能下微炎症的发生情况、心脏结构、营养状况及存活率情况。方法：腹膜透析患者腹膜透析治疗3个月～1年并除外炎症、肿瘤、急性冠脉综合症等伴随疾病的患者人选本研究，通过腹膜平衡试验（PET）判断腹膜通透性，根据试验结果将患者分为2组：高转运、高平均转运的患者为高通透性组（H／A；D／Pcreat≥0．65，D为透析液肌酐浓度，P为血浆肌酐浓度）；低转运和低平均转运患者为低通透性组（L／A；D／P〈0．65）。对入选患者随访26个月或腹膜治疗终点（死亡或转为血液透析或行肾移植），观察结束检测患者血CRP，了解患者微炎症的发生情况。同时检测患者的血白蛋白、血红蛋白、主观综合营养评估（SGA）、KT／Vurea，心脏B超检查记录各心腔的大小，计算左心室心肌重量指数，并对两组间生存率分析。结果：高通透性组CRP升高（CRP〉5mg／L）的比例大于低通透组（P〈0．05）；营养状况较低通透组差并普遍存在左心室肥大（P〈0．05），但小分子清除率方面差异无统计学意义（P〉0．05）；高通透组2年生存率79．24％，低通透性组两年生存率89．39％。结论：腹膜高通透性患者微炎症的发生率高于低通透性患者，且营养情况差，左心室肥大发生增加，存活率降低，提示我们对腹膜高通透性患者应早期给予干预措施以提高患者存活率、改善预后。Objective：To study the nutrition status,cardiac alleosis,micro-inflammation and subsequent survival with different peritoneal transportation functions for the patients with CAPD. Methods： One hundred and ninteen patients with no apparent inflammation or disease, who had been with CAPD for one-twelve months were included in this study. Peritoneal equilibration test was used to evaluate PSTR（peritoneal small-solute transport rate ）. Patients were divided into two groups： high-average and high transporters（H/A,D/Preat≥0. 65 ）and low-average and low transporters（L/A, D/PCreat〈0.65）. At the end of the study, the concentration of CRP was measured, the nutrition status was evaluated by albumin, hemoglobin Subjective global assessment （SGA） ,LAD,LVPWT,IVST were measured by echo-cardiogram and the survival by Kaplan-meier analysis. Results：There was a significant difference between two groups regarding prevalence of diabetes（P〈0. 01） ,the prevalence of malnutrition assessed by alb,SGA and hemoglobin was lower in the H/A group（P〈0.05 vs L/ A）and had shown to be associated with a lower survival. In terms of IVST,there was not significant difference between two groups. But LAD, LVDd, LVPWT, LVMI, LVEF in the H/A group were significantly higher than that in the L/A group（P〈0. 05）. Furthermore,the survival rate by Kaplan-Meier analysis was different between two groups,and survival rates for patients in H/A and L/A group showed 79.24%vs 89.39M ,P〈0.01. Conclusion.. High peritoneal transport status is a high risk factor for mortality,malnutrition and cardiac hypertrophy. Further studies are required to determine whether the adverse prognosis of high transporters can be improved by various therapeutic strategies so that these patients could have a better progress.

关 键 词：腹膜透析/持续不卧床 微炎症 肥大/左心室 营养状况 

分 类 号：R459.51[医药卫生—治疗学]