不同腹膜通透性对CAPD患者左心室结构的影响

发布时间：2018-06-02 00:25

  本文选题：腹膜透析 + 腹膜通透性　； 参考：《山西医科大学》2015年硕士论文

【摘要】：目的:探讨不同腹膜通透性对持续不卧床腹膜透析(CAPD)患者左心室结构的影响。方法:选择山西医科大学附属第一医院肾内科行腹膜透析患者45例,通过腹膜平衡试验(PET)判断腹膜转运功能,依照PET结果分为2组:高通透性组(H);低通透性组(L)。对所以入选的患者,将其透析前及透析12个月后,检测患者体内血红蛋白量(Hb)、血清白蛋白(ALB)、血钠、血氯、血钙、血磷、血浆甲状旁腺素(PTH)、总胆固醇(TC)、甘油三酯(TG)、C反应蛋白(CRP)等临床指标;检测患者血、尿及腹透液中的尿素氮(BUN)浓度、肌酐(Cr)浓度及血糖浓度,根据公式计算出患者尿素清除指数(KT/V)及残余肾小球滤过率,作为残余肾功能(RRF)评估的指标。同时收集患者心脏彩超结果,包括室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末内径(LVDd),并根据Reichek公式计算左心室心肌重量指数(LVMI)并进行统计学分析。结果:1.腹膜透析患者中LVMI与CRP及腹膜通透性呈正相关(r=0.328、0.427,P0.05),与Hb、ALB、RRF、KT/V呈负相关(r=-0.423、-0.383、-0.316、-0.317,P0.05);2.与腹膜低通透性的患者比较,腹膜高通透性的患者血红蛋白[(95.00±11.42)g/L比(112.25±8.39)g/L,P0.001]、白蛋白[(30.68±3.78)g/L比(40.09±4.35)g/L,P0.001]、RRF[(1.17±0.59)ml/min比(3.41±1.23)ml/min,P0.001]、KT/V[(1.85±0.47)比(2.32±0.83),P=0.035]明显降低,CRP[(4.53±3.72)mg/d L比(1.45±0.85)mg/d L,P=0.001]、LVMI[(147.75±25.33)g/m2比(110.31±30.41)g/m2,P=0.001]明显升高。结论:高通透性的腹膜透析患者左心室肥厚发生高于低通透性的腹膜透析患者,可能与营养不良、微炎症、透析不充分、残余肾功能下降有关系,提示我们应该早期对腹膜高通透性患者进行干涉。
[Abstract]:Aim: to investigate the effect of different peritoneal permeability on left ventricular structure in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods: Forty-five patients with peritoneal dialysis in the Department of Renal Medicine affiliated to the first affiliated Hospital of Shanxi Medical University were selected. Peritoneal transport function was evaluated by peritoneal balance test. According to the results of PET, they were divided into two groups: high permeability group and low permeability group. Before and 12 months after dialysis, the hemoglobin content, serum albumin, serum sodium, blood chlorine, blood calcium, blood phosphorus were measured. Plasma parathyroid hormone (PTH), total cholesterol (TC), triglyceride (TG) and C-reactive protein (CRP) were measured in blood, urine and peritoneal dialysate, and blood urea nitrogen (bun), creatinine (Cr) and blood glucose were measured. The urea clearance index (KT / V) and residual glomerular filtration rate (GFR) were calculated according to the formula. At the same time, the results of color Doppler echocardiography were collected, including septal thickness (IVST), left ventricular posterior wall thickness (LVPWTT), left ventricular end-diastolic diameter (LVDdD), and the left ventricular mass index (LVMI) calculated by Reichek formula. The result is 1: 1. In peritoneal dialysis patients, there was a positive correlation between LVMI and CRP and peritoneal permeability. There was a negative correlation between LVMI and CRP, and a negative correlation between LVMI and RRFRF / V in hemodialysis patients. 涓庤吂鑶滀綆閫氶，

本文编号：1966417