糖尿病终末期肾病患者透析方式的探讨

目的比较腹膜透析（PD）及血液透析（HD）对糖尿病终末期肾病患者长期预后的影响,以便为临床选取适当治疗方法提供参考。方法将131例糖尿病终末期肾病患者分为HD组（58例）和PD组（73例）,比较两组患者的血液生化指标、生存率和死亡原因。结果两组患者年龄比较无显著性差异,但大于65岁的老年糖尿病患者PD组明显增多（P〈0．01）。透析第1、第2年两组患者死亡率比较无显著性差异,第3、4年PD组死亡率大幅上升,显著高于HD组（P〈0．01）。HD组18例死亡患者中,年龄大于65岁者4例（22．2％）;PD组29例死亡患者中,年龄大于65岁者17例（58．6％）,两组比较有显著性差异（P〈0．01）。HD组死亡主要原因为脑血管病变（占38．9％）,PD组死亡主要原因为感染（占34．5％）。PD组空腹血糖、甘油三酯、胆固醇均高于HD组,两组比较差异有显著性（P〈0．01）。PD组患者血浆白蛋白、血钾明显低于HD组（P〈0．01）。结论糖尿病终末期肾病患者适于PD,但PD组患者2年以上远期生存率明显低于HD组,尤其是大于65岁高龄糖尿病患者PD死亡率明显上升。腹膜透析相对于血液透析仍存在局限性。

Comparison of hemodialysis and peritoneal dialysis in patients with diabetes

Objective To provide the reference for clinical therapy,we compared the influencing factors on the prognosis of peritoneal dialysis （PD） and hemodialysis （HD） in the diabetes meUitus with end-stage renal disease patients. Methods 131 diabetes patients with ESRD were divided into 2 groups, HD group 58 and PD 73. We observed and compared the biochemical indicators, mortality rate and death causes between the two groups. Results The Age between the two groups had no significant difference, but the old DM patients（over 65 years old） in PD are more than those in HD（P 〈0.01 ）. The mortality rates in the first 2 years of dialysis had no difference in PD and HD groups. PD group had a increase in the mortality rate in the last 2 years of dialysis, compared with HD group（ P 〈 0.01 ）. There are 4 patients over 65 years old in 18 death patients HD group（22.2% ） and 17 patients over 65 years old in 29 death patients HD group （58.6%）. The death caused by cerebrovascular disease accounted for 38.9% in HD group, while by infections accounted for 34.5 % in PD group. The fast serum glucose, triglyceride and cholesterol in PD patients were higher than those in HD patients（ P 〈 0.01 ）. The serum albumin and kalium in PD patients were lower than those in HD patients （ P 〈 0.01 ）. Conclusions PD is suitable for diabetic patients with end - stage renal disease, butthe third, forth-year survival rates of dialysis in PD patients were lower than those in HD patients, especially the old DM patiants over 65 years old. Compared with HD,PD had some limitations.