腹膜转运类型与腹膜炎、微炎症关系的研究  

Observation on Relationship between Peritoneal Transport Type and Peritonitis,Microinflammatory

作　　者：林克宣[1] 雷蕾[2] 黄成文[1] 郑庆发[1] 白建祥 黄润浓 石咏军[1] 刘冠贤[1] 

机构地区：[1]广东省惠州市中心人民医院,广东惠州516001 [2]广东省惠州市第一人民医院

出　　处：《中国医学创新》2015年第19期1-6,共6页Medical Innovation of China

基　　金：广东省医学科学技术研究基金(A2013776)

摘　　要：目的：观察不同腹膜转运类型的CAPD患者腹膜炎发生前微炎症、容量及营养指标的变化情况,分析腹膜转运类型、腹膜炎以及微炎症状态的相关关系。方法：CAPD患者行腹膜透析置管术1个月后至3个月内行腹膜平衡实验（Peritoneal equilibration test,PET）明确转运类型,并依结果分成甲组（非快速转运）及乙组（快速转运）,入选患者从腹透第3个月开始监测实验指标,包括超敏C反应蛋白（hs CRP）、白细胞介素6（IL-6）、收缩压（SBP）、舒张压（DBP）、血B型钠尿肽前体（pro-BNP）、前白蛋白（PA）、白蛋白（ALB）等,此后每2~4个月监测1次,共完成4次监测,观察终止事件为发生腹膜炎,并作相关性分析。结果：乙组较甲组的微炎症指标、平均BP及pro-BNP水平高,且随腹透时间的延长,此动态演变在发生腹膜炎的患者中体现的更明显,比较差异有统计学意义（P〈0.05）。血ALB、PA体现为乙组低于甲组,有腹膜炎患者低于无腹膜炎患者,腹透早期随着时间的延长,两者在观察乙组中有下降趋势,差异有统计学意义（P〈0.05）。快速腹膜转运患者的IL-6、hs-CRP与PA、ALB呈负相关,与pro-BNP及腹膜炎的发生呈正相关（P〈0.05）。结论：腹膜快速转运患者较非快速转运患者具有较为明显的微炎症状态,炎症因子与超容量负荷以及营养不良状态密切相关,三者互为因果相互作用,促进了腹膜快速转运患者腹膜炎的发生发展。Objective：To observe the microinflammatory,volume,nutritional indicators with different peritoneal transport type in CAPD patients before peritonitis occurs,and analyze the possible relationship between peritonitis,microinflammation and peritoneal transport type.Method：Patients proceeded the peritoneal equilibration test between first month and third month after accepting the peritoneal dialysis tube placement surgery.Group A（Non-fast transport） and group B（fast transport） were divided considered by the test result.The patients were detected lab indicators from the third peritoneal dialysis month,including hs CRP,IL-6,SBP,DBP,pro-BNP,PA,ALB,and then the same detection was conducted once every 2-4 months,which has been completed 4 times observe termination was event of peritonitis.Correlation analysis was done after the observation.Result：Group B showed a higher microinflammation,average blood pressure and pro-BNP level than group A,meanwhile the above indicators in patients with peritonitis were also higher than patients without peritonitis in peritoneal dialysis stage（P〈0. 05）.The blood albumin,prealbumin both presented a lower level in group B than in group A,and in peritonitis patients than in non-peritonitis patients,with the time prolonged during the early dialysis stage,both in the observation group B presented descend trend significantly（P〈0. 05）.IL-6 and hs CRP were correlated with PA and ALB negatively（P〈0. 05）,and were correlated with pro-BNP as well as peritonitis positively in patients with fast peritoneal transport（P〈0. 05）.Conclusion：The microinflammatory status is more serious in patients with peritoneal fast transport than those are not,which is correlated with volume overload and poor nutrition status,the three factors plays an important role in the development of the fast peritoneal transport patients with peritonitis by interact causally.

关 键 词：腹膜炎 腹膜转运类型 微炎症 

分 类 号：R572.2[医药卫生—消化系统]