蛋白尿对腹膜透析患者残余肾功能的影响探讨  

Effect of Proteinuria on Residual Renal Function in Peritoneal Dialysis Patients

作　　者：金骊珠[1,2] 陈泽君[1,2] 龚蓉[1,2] 杨斌[1,2] 舒英[1,2] 全大勇[1,2] 童玉娜[1,2] 

机构地区：[1]重庆医科大学附属成都第二临床学院 [2]成都市第三人民医院肾脏科,成都610031

出　　处：《华西医学》2014年第12期2205-2208,共4页West China Medical Journal

基　　金：四川省卫生厅科研课题(120541)~~

摘　　要：目的探讨不同蛋白尿水平与腹膜透析患者残余肾功能(RRF)的关系。方法收集2011年1月-2013年1月开始腹膜透析的45例患者资料,根据其初始尿蛋白水平分为大量蛋白尿(n=20)及非大量蛋白尿组(n=25)并定期随访,研究蛋白尿及可能对RRF下降相关的影响因素。结果随访12个月后RRF>基线50%的患者在大量蛋白尿组和非大量蛋白尿组分别为13例(65%)和20例(80%),差异有统计学意义(P<0.05),而单因素及多因素分析则提示非大量蛋白尿、较高基础残余肾小球滤过率(r GFR)在RRF下降中具有保护作用(P<0.05)。结论对于腹膜透析患者来说,大量蛋白尿、更低的基线r GFR预示着RRF的下降更显著,因而降低尿蛋白的治疗措施可能有利于保护RRF,从而改善腹透患者生存质量。Objective To observe whether proteinuria is relate to the decline of residual renal function （RRF） in peritoneal dialysis （PD） patients. Methods This is a prospective cohort study including 45 PD patients （underwent PD between January 2011 and January 2013） with a 12-month follow-up. All the patients were divided into 2 groups with respect to the initial proteinuria level： massive proteinuria group A （n=20） and non-massive proteinuria group B （n=25） at baseline. We established regression models to do univariate analysis and multivariate analysis of the relationship between the decline of RRF I〉 50% of baseline and the indices of age, sex, PD-associated peritonitis, baseliner residual glomerular filtration rate （rGFR）, initial proteinuria, and use of ACEI/ARB. Results The primary outcome （RRF 〉 50% of baseline） at 12 months was 65% in group A, and 80% in group B （P 〈 0.05）. Based both on the results of univariate and multivariate Cox regression analysis, non- massive proteinuria and higher rGFR at baseline were factors to protect RRF from decline （P 〈 0.05）. Conclusions The study demonstrates that massive proteinuria and lower rGFR at baseline may be associated with a rapid decline of RRF in PD patients. Treatment aimed at reducing albuminuria may lead to protect RRF and improve life quality of patients.

关 键 词：慢性肾脏病 腹膜透析 蛋白尿 残余肾功能 影响因素 

分 类 号：R459.5[医药卫生—治疗学]