高通量血液透析前后不同时点终末期肾病患者血脂水平及其与预后的关系  

Serum lipid level and the relationship with prognosis in patients with end-stage renal disease before and after high-flux hemodialysis

作　　者：段瑞秋 薄天慧[1] 赵伟[1] Duan Ruiqiu;Bo Tianhui;Zhao Wei(Department of Nephrology,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院肾内科,100144

出　　处：《国际移植与血液净化杂志》2019年第6期12-15,共4页International Journal of Transplantation and Hemopurification

摘　　要：目的探讨终末期肾病(end-stage renal disease,ESRD)患者在进入高通量透析前1年、进入透析时(基线水平)、透析后1、2、3、4年血脂的变化,并分析高通量透析时血脂对患者预后的影响.方法选取有完整资料的122例ESRD患者,收集其一般资料、透析前1年的血红蛋白、血脂、血肌酐、血白蛋白、血C-反应蛋白,进入透析时上述生化指标,并于高通量透析后随访4年,观察4年间血脂变化,分析高通量透析时血脂与预后的关系.结果单因素方差分析提示透析前1年的血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、非高密度脂蛋白胆固醇(非HDL)水平均高于透析即刻和透析后1年,透析后1年与透析后2、3、4年相比,上述指标无明显变化,而高密度脂蛋白胆固醇(HDL)在透析前1年、透析即刻及透析后均无明显变化.4年随访期间,共有35例患者死亡,死亡组患者透析前1年及透析即刻血TC、非HDL均明显高于存活组,而透析后1年血脂各项在死亡组和存活组间差异无统计学意义.以刚进入透析时的非HDL均值为界,分为高非HDL组和低非HDL组,两组在透析后1年、透析后4年的死亡率比较差异无统计学意义.结论高通量透析可以改善ESRD患者的血脂代谢,透析后1年血脂趋于稳定,透析前的血脂水平对预后有影响,高通量透析可以部分改善血脂对患者的不良影响.Objective To investigate the changes of serum lipids in patients with end-stage renal disease(ESRD)at 1 year before dialysis,just entering dialysis(baseline level),1,2,3 and 4 years after dialysis,and to analyze the effect of serum lipids on prognosis during high-flux dialysis.Methods A total of 122 patients with end-stage renal disease were selected.The demographic characteristics,serum lipids,uric acid,albumin,hemoglobin and other data were collected at the beginning of high-flux dialysis,1 year before dialysis and 1,2,3,4 years after dialysis respectively.The changes of serum lipids during different periods and the effect of serum lipids on prognosis during high-flux dialysis were analyzed.Results Univariate analysis of variance showed that the levels of serum triglyceride(TG),total cholesterol(TC),low-density cholesterol(LDL)and non-high density cholesterol(non-HDL)at one year before dialysis were all higher than those in baseline and after high-flux dialysis.And these indexes above in baseline were higher than in 1 year after dialysis.But these indexes did not change between 1,2,3 and 4 years after high-flux dialysis.In particular,HDL did not change significantly.35 of 122 patients died during 4 years.TC and non-HDL levels at one year before dialysis and baseline in the death group were significantly higher than those in the survival group,but there was no difference in lipid levels in 1 year after high-flux dialysis.According to the mean value of non-HDL at baseline,the patients were divided into high non-HDL group and low non-HDL group.There was no difference in the all-cause mortality between the two groups at 1 year and 4 years after dialysis by Kaplan-Meier analysis.Conclusions Our study suggests that high flux dialysis can improve serum lipids metabolism in ESRD patients.The lipids levels tend to be stable one year after high-flux dialysis.The serum lipids before dialysis are significantly for prognosis.High flux dialysis can partly rectify the adverse effects of serum lipids and further improve outcom

关 键 词：终末期肾病 高通量血液透析 血脂代谢 

分 类 号：R69[医药卫生—泌尿科学]