腹膜炎对腹透患者营养状况的后续影响  

The Influence of Peritonitis on Nutritional Status in Peritoneal Dialysis Patients

作　　者：钱宝 李昭 吕晶 毋欣彤 梁嫦娜 马莹 王晓培 耿瀛洲 路万虹[1] QIAN Bao;LI Zhao;LV Jing(Department of Nephrology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an,710061)

机构地区：[1]西安交通大学第一附属医院肾脏病医院肾内科,西安710061

出　　处：《中国中西医结合肾病杂志》2023年第1期29-33,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：西安交通大学第一附属医院临床科研项目面上项目(No.XJTU1AF-CRF-2019-017)。

摘　　要：目的:通过回顾单中心腹膜透析腹膜炎(peritoneal dialysis-associated peritonitis, PDAP)患者出现PDAP前后营养状况及残肾功能的比较,探讨改善PDAP后非感染相关并发症的方法。方法:回顾2019年01月—2020年12月单中心PDAP患者,调查患者PDAP前后3月内及期间白蛋白,CRP水平,腹膜转运功能及残肾功能,比较其变化。结果:共126例,发生了166例次PDAP,PDAP时白蛋白较PDAP前明显下降[(28.98±8.10)g/L vs(34.00±5.43)g/L,P<0.001],PDAP后白蛋白较感染时改善(P<0.001),但仍低于PDAP前水平[(32.99±5.92)g/L vs (34.00±5.43)g/L,P<0.001]。PDAP后残肾KT/V下降(P=0.010),总KT/V下降(P=0.007),PDAP前后PET 4 h肌酐D/P,超滤量比较差异无统计学意义。多因素logistics逐步回归示:感染期间高CRP水平(OR=1.016,P=0.029),PDAP前低蛋白血症(OR=5.712,P=0.032)是导致PDAP后低蛋白血症的独立危险因素。PDAP后白蛋白水平变化与GFR下降呈正相关(R=0.314,P=0.004)。结论:对于残肾较差,已存在低蛋白血症的PD患者,PDAP是加速营养状态恶化和残肾丢失的原因。PDAP控制后应加强对透析充分性及营养状况的持续监测。Objective:To study the effects of nutritional status on residual renal function after the control of peritoneal dialysis-associated peritonitis(PDAP)and to explore the way to improvethe clinic prognosis afterPDAP.Methods:Albumin was detected 3 months before and within 1 to 3 months after peritonitis.A repeat PET test was performed within 3 months of peritonitis.The changes of 4 h D/PCcr,albumin and residual renal function before and after peritonitis were analysed.Results:A total of 126 PD patients occurred 166 peritonitis on single-center were involved in this study.The albumin level decreased significantly during the period of the peritonitis(P<0.001)and improved after peritonitis(P<0.001).However,the albumin level were significant lower than that before peritonitis(P<0.001).After peritonitis,uKT/V(P=0.010),total KT/V(P=0.007),urine volume(P=0.018)were significant decreased after peritonitis,and the PET 4 h creatinie D/P,ultrafiltration,pKT/V were not different before and after peritonitis in those patients.Multivariate logistics stepwise regression showed that high CRP level during the period of peritonitis(OR=1.016,P=0.029)and hypoproteinemia before peritonitis(OR=5.712,P=0.032)were independent risk factors for hypoproteinemia after peritonitis.The changes of albumin level after peritonitis were positively correlated with the decrease of GFR(R=0.314,P=0.004).Conclusion:Peritonitis is more likely to accelerate nutritional deterioration and decrease GFR in those PD patients who with poor residual renal function and Hypoproteinemia.The continuous monitoring of dialysis adequacy and nutritional status should be strengthen after peritonitis control.

关 键 词：腹膜炎 营养 残肾功能 

分 类 号：R692.5[医药卫生—泌尿科学] R572.2[医药卫生—外科学]