腹膜透析与血液透析治疗糖尿病肾病的对比研究  

Hemodialysis Versus Peritoneal Dialysis in Patients with Diabetic Nephropathy

作　　者：陈海高 廖新媛 刘日光[2] 

机构地区：[1]云浮市人民医院,广东云浮527300 [2]广州市第一人民医院,广东广州510080

出　　处：《临床医学工程》2015年第1期17-19,共3页Clinical Medicine & Engineering

摘　　要：目的比较血液透析和腹膜透析治疗终末期糖尿病肾病的早期疗效。方法 2013年1月至2014年3月,72例终末期糖尿病肾病患者随机分成血液透析(hemodialysis,HD)治疗组和腹膜透析(peritoneal dialysis,PD)治疗组,各36例。对两组进行前瞻性比较研究,观察指标包括血压、尿量、钙磷、血脂、白蛋白、血红蛋白、24 h尿蛋白量、24 h净超滤量、心脑血管并发症及腹膜透析相关性腹膜炎等。采用肾小球滤过率(r GFR)评估患者残余肾功能;采用每周总尿素氮清除率(Kt/V)、每周总肌酐清除率(Ccr)评估透析充分性。结果透析6个月后,72例患者中69例获得随访,HD组死亡脱落1例,PD组中脱落2例。两种透析方式均可引起收缩压和舒张压下降,PD治疗组的下降更明显,组间比较有统计学差异(P<0.05);两组中的白蛋白、血红蛋白等营养状态指标均有所升高,但HD治疗组的升高更明显,组间比较有统计学差异(P<0.05);HD治疗可使甘油三酯和总胆固醇稍下降,但PD治疗后患者的甘油三酯和总胆固醇均显著升高,组间比较有统计学差异(P<0.05);HD治疗后患者的尿量显著减少,而PD治疗组的则稍减少,组间比较有统计学差异(P<0.05)。6个月后,两组患者间残余肾功能和透析充分性比较,差异均无统计学意义(P>0.05)。结论血液透析和腹膜透析均是治疗终末期糖尿病肾病的有效方法,近期疗效相近,并发症方面各有优缺点。Objective To evaluate and compare the short-term outcomes of hemodialysis and peritoneal dialysis in patients with end-stage diabetic nephropathy. Methods Seventy-two patients with end-stage diabetic nephropathy from January 2013 to March 2014 were selected and randomly divided into the hemodialysis group（HD group） and the peritoneal dialysis group（PD group）, with 36 cases in each group. Prospective comparative study was taken between two groups. The blood pressure, urine output, serum calcium, phosphorus,triglyceride, serum albumin（Alb）, hemoglobin（Hb）, 24-hour urinary protein, 24-hour ultrafiltration and related complications were compared between the two groups. r GFR was used to evaluate the residual renal function, and the total weekly Kt/V and Ccr were calculated to evaluate adequacy of dialysis. Results Six months after dialysis, 69 cases in 72 subjects were followed up, with one off case in HD group and 2 off cases in PD group. Systolic and diastolic blood pressure decreased in both groups, and PD group decreased more significantly, with significant difference between the two groups（P〈0.05）. The serum albumin（Alb） and hemoglobin（Hb） increased in both groups, and HD group increased more significant, with significant difference between the two groups（P〈0.05）. The triglyceride and total cholesterol decreased in HD group, and increased in PD group, with significant difference between the two groups（P〈0.05）. The 24-hour urine volume decreased significantly in HD group compared with that in PD group（P〈0.05）. The two groups had no significant difference in residual renal function and adequacy of dialysis（P〉0.05）. Conclusions Both HD and PD are efficient renal replacement therapies, and may lead to comparable short-term outcomes in patients with end-stage diabetic nephropathy.

关 键 词：血液透析 腹膜透析 终末期 糖尿病肾病 

分 类 号：R587.2[医药卫生—内分泌]