腹膜透析对ESRD伴肝硬化大量腹水患者腹膜蛋白清除率及营养状况的影响  

Effects of peritoneal dialysis on peritoneal protein clearance rate and nutritional status in patients with ESRD complicated with massive ascites due to liver cirrhosis

作　　者：陈香慧 马芳霞 杨静[1] 张晶晶[1] 李孟玉 付荣国[1] 陈钊[1] CHEN Xianghui;MA Fangxia;YANG Jing;ZHANG Jingjing;LI Mengyu;FU Rongguo;CHEN Zhao(Nephrology Department,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院肾病科,陕西西安710004

出　　处：《临床医学研究与实践》2022年第28期5-8,共4页Clinical Research and Practice

基　　金：国家自然科学基金青年项目(No.82000699)。

摘　　要：目的探讨腹膜透析(PD)在终末期肾病(ESRD)伴肝硬化大量腹水患者中的应用效果。方法选择2016年11月至2020年11月在我院肾病科住院并行PD治疗的18例ESRD伴肝硬化大量腹水患者,分析其转归情况。比较PD治疗后生存时间≥12个月患者不同时间的一般资料、实验室指标、营养状况指标[上臂围(MAC)、肱三头肌皮褶厚度(TSF)、上臂肌围(MAMC)]、腹膜蛋白清除率。记录腹膜炎发生情况。结果随访至2021年11月31日,8例患者PD治疗后生存时间≥12个月,10例患者PD治疗后生存时间<12个月。治疗后1个月,患者自觉腹胀、乏力、纳差等症状得到改善。治疗后1个月,患者的总胆红素、尿素氮、血肌酐、血尿酸、血磷水平低于治疗前(P<0.05)。治疗后6、12个月,患者的MAC、TSF、MAMC大于治疗前(P<0.05)。治疗后3、6、12个月,患者的腹膜蛋白清除率低于治疗后1个月(P<0.05)。肝硬化PD患者2018—2020年的腹膜炎发生率高于同期非肝硬化PD患者。结论随着治疗时间的延长,非腹膜炎状态下腹膜蛋白清除率逐渐下降且趋于稳定,营养状况逐步改善。对于ESRD伴肝硬化大量腹水患者,PD可能是其首选肾脏替代治疗方式。Objective To investigate the application effect of peritoneal dialysis(PD)in patients with end-stage renal disease(ESRD)complicated with massive ascites due to liver cirrhosis.Methods From November 2016 to November 2020,18 patients with ESRD complicated with massive ascites due to liver cirrhosis hospitalized in the nephrology department of our hospital and treated with PD were selected,and their outcomes was analyzed.The general data,laboratory indexes,nutritional status indexes[mid-arm circumference(MAC),triceps skinfold thickness(TSF)and mid-arm muscle circumference(MAMC)]and peritoneal protein clearance at different times of patients with survival time≥12 months after PD treatment were compared.The occurrence of peritonitis was recorded.Results From the follow-up to November 31,2021,the survival time of 8 patients after PD treatment was greater than or equql to 12 months,the survival time of 10 patients after PD treatment was less than 12 months.At 1 month after treatment,the patients’symptoms such as abdominal distension,fatigue and poor appetite were improved.At 1 month after treatment,the levels of total bilirubin,urea nitrogen,blood creatinine,blood uric acid and blood phosphorus of patients were lower than those before treatment(P<0.05).At 6 and 12 months after treatment,the MAC,TSF and MAMC of patients were greater than those before treatment(P<0.05).At 3,6 and 12 months after treatment,the peritoneal protein clearance rate was lower than that at 1 month after treatment(P<0.05).The incidence of peritonitis in liver cirrhosis PD patients from 2018 to 2020 was higher than that in non-liver cirrhosis PD patients in the same period.Conclusion With the prolongation of treatment time,the peritoneal protein clearance rate in non-peritonitis state gradually decreased and tended to be stable,the nutritional status has gradually improved.For ESRD patients complicated with massive ascites due to liver cirrhosis,PD may be the first choice of renal replacement therapy.

关 键 词：终末期肾病 肝硬化 腹膜透析 腹膜蛋白清除率 

分 类 号：R692[医药卫生—泌尿科学]