慢性肾功能衰竭患者血清叶酸水平及其相关分析

发布时间：2018-06-10 13:21

本文选题：慢性肾功能衰竭 + 血液透析　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：研究慢性肾功能衰竭患者血清叶酸水平及其相关因素分析，了解血液透析、腹膜透析对维持性透析患者血清叶酸水平的影响。方法：选取2013年9月-2014年3月在大连医科大学附属第二医院住院患者59例，均诊断为慢性肾功能不全尿毒症期CKD5期。其中血液净化中心维持性血液透析（HD）患者23例，持续非卧床腹膜透析（CAPD）患者16例，暂未行透析治疗患者20例，健康体检人员25例。分组方式：1）将住院明确诊断为慢性肾衰竭尿毒症期患者59例作为尿毒症组，健康体检人员25例作为正常对照组，通过观察59名慢性肾功能衰竭患者叶酸水平估计整体慢性肾功能衰竭患者叶酸水平。2）根据透析与否、透析方式将慢性肾衰竭患者分为血透组、腹透组、未透组，健康体检人员25例作为正常对照组，比较各组别血清叶酸水平。3）血液透析患者按透析前、透析后分为透前组、透后组，研究血液透析对于血清叶酸清除情况。结果：59名慢性肾功能衰竭患者血清叶酸水平：9.21±4.5ng/ml，维生素B12水平650±229pg/ml。其中血清叶酸水平低于正常值共12例，占总数20.3%，正常水平46例，占78.0%，高于正常水平1例，占1.7%。血透组患者叶酸水平低于正常6例，占血透患者26.1%，正常水平16例，占69.7%,高于正常水平1例，占4.2%。其中腹透组患者叶酸水平低于正常5例，占腹透患者31.2%，正常水平11例，占68.8%，高于正常水平0例。未透组患者叶酸水平低于正常1例，占5%，正常水平19例，占95%，高于正常水平0例，占0%。其中正常对照组叶酸水平低于正常0例，正常水平24例，占96%，高于正常水平1例，占4%。血透组患者血清叶酸水平9.3±4.1ng/ml，腹透组8.55±4.3ng/ml，未透组9.5±4.2ng/ml，正常对照组11.1±4.3ng/ml，尿毒症患者血清叶酸水平低于正常对照组，有显著性差异（p0.05），血透组、腹透组叶酸水平明显低于正常对照组，有显著性差异（p0.05）。未透析组患者血清叶酸水平低于正常对照组，，无显著性差异（p0.05）,腹膜透析组叶酸水平低于血液透析组叶酸水平，但无显著性差异（p0.05）.血液透析患者透析前与透析后叶酸水平有显著差异（p0.05）。尿毒症患者血清叶酸水平与维生素B12水平呈正相关（p0.05），与血红蛋白、平均红细胞体积、血清铁、铁蛋白、尿毒氮、血肌酐、白蛋白水平无相关性。尿毒症患者中低叶酸血症患者平均血红蛋白80.7±9.7g/l，血清叶酸水平正常的尿毒症者平均血红蛋白含量为95.1±11.6g/l，二者有显著性差异（p0.05）。结论：慢性肾功能衰竭患者血清叶酸平均水平低于正常人群血清叶酸水平，血液透析、腹膜透析患者血清叶酸水平均低于正常人群。腹膜透析与血液透析患者血清叶酸水平无明显差异。血液透析可以清除透析患者血液中部分叶酸。慢性肾功能衰竭患者叶酸水平与维生素B12水平正相关，叶酸缺乏能够加重慢性肾功能衰竭患者贫血程度。
[Abstract]:Objective: to study the serum folic acid level and its related factors in patients with chronic renal failure (CRF). Effect of peritoneal dialysis on serum folic acid levels in patients with maintenance dialysis methods: 59 hospitalized patients in the second affiliated Hospital of Dalian Medical University from September 2013 to March 2014 were all diagnosed as chronic renal insufficiency stage CKD5. Among them, 23 patients with maintenance hemodialysis (HD), 16 patients with continuous ambulatory peritoneal dialysis (CAPDD), 20 patients who were not undergoing dialysis treatment and 25 healthy persons. (1) 59 cases of uremic patients who were definitely diagnosed as chronic renal failure (CRF) were treated as uremia group, and 25 healthy persons as normal control group. By observing the folic acid level of 59 patients with chronic renal failure (CRF), the patients with CRF were divided into three groups: hemodialysis group, abdominal dialysis group, incomplete dialysis group. 25 healthy persons were used as normal control group. The serum folic acid levels of each group were compared. The patients were divided into pre-dialysis group, post-dialysis group, pre-dialysis group and post-dialysis group. Results the serum folic acid level was 9. 21 卤4. 5 ng / ml and vitamin B12 level was 650 卤229 PG / ml in 59 patients with chronic renal failure. The serum folic acid level was lower than normal in 12 cases (20.3%) and normal level in 46 cases (78.0%), which was higher than normal level in 1 case (1.7%). In the hemodialysis group, folic acid level was lower than normal in 6 cases, accounting for 26.1in hemodialysis patients, normal level in 16 cases (69.7%), and higher than normal level in 1 case (4.2%). In the peritoneal dialysis group, folic acid level was lower than normal in 5 cases, accounting for 31.2%, normal level was 11 cases (68.8%), and above normal level was 0 cases. The level of folic acid was lower than normal in 1 case (5 cases), normal in 19 cases (95%), higher than normal level in 0 cases (0%). In the normal control group, folic acid level was lower than 0 cases, normal level was 24 cases (96%), higher than normal level in 1 case (4%). The serum folic acid level was 9.3 卤4.1 ng / ml in hemodialysis group, 8.55 卤4.3 ng / ml in peritoneal dialysis group, 9.5 卤4.2 ng / ml in underpenetration group and 11.1 卤4.3 ng / ml in normal control group. The serum folic acid level in uremic patients was significantly lower than that in normal control group (P 0.05). The folic acid level in hemodialysis group and peritoneal dialysis group was significantly lower than that in normal control group. There was significant difference (P 0.05). The level of folic acid in the patients with peritoneal dialysis was lower than that in the hemodialysis group, but there was no significant difference between the two groups (p 0.05). The serum folic acid level in the patients without dialysis was lower than that in the normal control group (p 0.05), but the level of folic acid in peritoneal dialysis group was lower than that in hemodialysis group. The level of folic acid in hemodialysis patients was significantly different from that before and after dialysis (p 0.05). There was a positive correlation between serum folic acid level and vitamin B12 level, but no correlation with hemoglobin, mean erythrocyte volume, serum iron, ferritin, urinary toxic nitrogen, serum creatinine and albumin levels. The mean hemoglobin of patients with low and middle folic acidemia was 80.7 卤9.7 g / l, and that of uremia patients with normal serum folic acid level was 95.1 卤11.6 g / l, there was significant difference between them (p 0.05). Conclusion: the mean serum folic acid level in patients with chronic renal failure is 95.1 卤11.6g / l. Conclusion: the mean serum folic acid level in patients with chronic renal failure is higher than that in patients with chronic renal failure. The level of serum folic acid was lower than that of normal population. The serum folic acid levels in hemodialysis and peritoneal dialysis patients were lower than those in normal subjects. There was no significant difference in serum folic acid levels between peritoneal dialysis patients and hemodialysis patients. Hemodialysis can remove part of folic acid in the blood of dialysis patients. Folic acid levels were positively correlated with vitamin B12 levels in patients with chronic renal failure, and folic acid deficiency aggravated anemia in patients with chronic renal failure.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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