透析方式对非糖尿病终末期肾脏病患者临床指标及胰岛素抵抗影响的比较  

Dialysis modality on clinical indicators and insulin resistance in non-diabetic patients with end-stage renal disease

作　　者：曾海鸥[1] 陈圳炜[1] 罗敏虹[1] 袁丽萍[1] 伍强[1] 何东玲[1] 杨铁城[1] 

机构地区：[1]广东深圳市第四人民医院肾内科,深圳518000

出　　处：《中国血液净化》2016年第4期219-225,共7页Chinese Journal of Blood Purification

基　　金：深圳市福田区卫生公益性科研项目(NO.FTWS201309)

摘　　要：目的比较血液透析（hemodialysis,HD）及腹膜透析（peritoneal dialysis,PD）对非糖尿病终末期肾病（end stage renal disease,ESRD）患者临床指标及胰岛素抵抗（insulin resistance,IR）的影响,为非糖尿病ESRD患者透析方式选择及临床综合治疗提供参考。方法 2012年9月至2014年2月在深圳市第四人民医院住院的成人（年龄〉18岁）非糖尿病ESRD患者,血压控制平稳（小于140/90mm Hg）准备行透析治疗,随机分成HD组（n=32）及PD组（n=30）。透析前、透析后6月、透析后12月分别检测相关临床指标,包括体质量指数（body mass index,BMI）、腹围（abdominal circumference,AC）、血红蛋白（hemoglobulin,HGB）、超敏C反应蛋白（hypersensitive C-reactive protein,hs CRP）、尿素氮（blood urea nitrogen,BUN）、肌酐（serum creatinine,Scr）、尿酸（uric acid,UA）、血钙（calcium,Ca）、血磷（phosphorous,P）、血钙磷乘积（Ca×P）、全段甲状旁腺素（intact parathyroid hormone,i PTH）、血清白蛋白（albumin,ALB）、三酰甘油（triglyceride,TG）、总胆固醇（total cholesterol,TC）、低密度脂蛋白（low density lipoprotein,LDL）、高密度脂蛋白（high density lipoprotein,HDL）、糖化血红蛋白A1C（Hb Al C）、空腹血糖（fasting blood glucose,FBG）、空腹真胰岛素（fasting insulin,FINS）,评估患者IR指数（insulin resistance index,IRI）。比较HD及PD对临床指标及IR的影响。结果 1透析治疗前,上述临床指标HD组与PD组的组间比较均无统计学意义;透析治疗6月后,HD组与PD组相比,hs CRP[（6.91±4.75）mg/L比（4.20±3.68）mg/L,t=2.494,P=0.015]、ALB[（33.07±2.10）g/L比（30.31±3.47）g/L,t=3.851,P=0.000]HD组患者较PD组患者高,而Ca[（2.27±0.15）mmol/L比（2.43±0.15）mmol/L,t=-4.150,P=0.000]、Ca×P[（57.38±7.17）mg2/dl2比（61.49±7.83）mg2/dl2,t=-2.159,P=0.035]、TC[（4.94±0.72）mmol/L比（5.50±1.04）mmol/L,t=-2.482,P=0.016]、TG[（1.52±0.40）mmol/L比�Objective To compare the effect of hemodialysis（HD） and peritoneal dialysis（PD） on clinical indicators and insulin resistance（IR） in non-diabetic patients with end-stage renal disease（ESRD） in order to provide guidelines for non- diabetic patients with ESRD to select appropriate dialysis modality and to improve the comprehensive treatment. Methods A total of 62 non- diabetic adult（18 years old） patients with ESRD were enrolled in this study. They hospitalized in our hospital between Sept. 2012 and Feb. 2014,had stable blood pressure（140/90 mm Hg）, and were ready for dialysis. They were then divided into HD（n=32） group and PD group（n=30）. Clinical indicators including body mass index（BMI）, abdominal circumference（AC）, hemoglobin（HGB）, hypersensitive c-reactive protein（hs CRP）, serum albumin（ALB）, urea nitrogen（BUN）, serum creatinine（Scr）, uric acid（UA）, serum calcium（Ca）, phosphorus（P）, calcium-phosphorus product（Ca×P）, intact parathyroid hormone（i PTH）, albumin（ALB）, triglyceride（TG）, total cholesterol（TC）,low density lipoprotein（LDL）, high density lipoprotein（HDL） glycosylated hemoglobin（Hb A1C）, fasting blood glucose（FBG）, true fasting insulin（FINS）, and insulin resistance index（IRI） were examined before dialysis and after the dialysis for 6 months and 12 months. The effects of HD and PD on clinical indicators and IR were then assayed. Results 1 There were no statistical differences in these clinical indicators between HD and PD groups before dialysis. When clinical indicators after 6 months of dialysis were compared between HD group and PD group, hs CRP（6.91 ± 4.75 mg/L vs. 4.20 ± 3.68 mg/L, t=2.494, P=0.015） and ALB（33.07±2.10 g/L vs. 30.31±3.47 g/L, t=3.851, P=0.000） were higher in HD group than in PD group; Ca（2.27±0.15 mmol/L vs. 2.43±0.15 mmol/L, t=-4.150, P=0.000）, Ca×P（57.38±7.17 mg2/dl2 vs. 61.49±7.83 mg2/dl2,t=-2.159, P=0.035）, TC（4.94±0.72 mmol/L vs. 5.50±1

关 键 词：透析方式 终末期肾病 胰岛素抵抗 临床指标 

分 类 号：R692.3[医药卫生—泌尿科学]