糖尿病肾病腹膜透析患者血管内皮功能的变化

目的比较糖尿病肾病腹膜透析患者与非糖尿病肾病腹膜透析患者的内皮功能并分析内皮功能不全的相关因素。方法选择腹膜透析中心透析龄〉3个月的糖尿病肾病患者39例和非糖尿病肾病患者61例。所有患者均测量容量和血压，采用血流介导的肱动脉扩张法测定血流介导的血管扩张（FMD）。结果糖尿病肾病组患者收缩压、脉压、细胞外液明显高于非糖尿病肾病组（P〈0．05），而血管扩张显著低于非糖尿病肾病组组（P〈0．01）。血管扩张与身高、体重、收缩压、细胞外液、细胞内液呈显著负相关（P〈0．05）。多元逐步回归分析显示细胞外液、有无糖尿病肾病为血管扩张的独立预测因素（总r2=0．261，P〈0．01）。结论糖尿病肾病腹膜透析患者有较严重的内皮功能不全，细胞外液、有无糖尿病肾病是内皮功能不全的独立预测因素。

The change of endothelial function in peritoneal dialysis patients with diabetic nephropathy

Objective To compare the endothelial function between peritoneal dialysis（PD） patients with diabetic nephropathy（DN） and without DN,and analyze the relative factors. Methods The 39 DN patients and 61 non-DN patients with PD treatment for at least 3 months in dialysis center were enrolled. All patients underwent blood pressure measurements. Volume status was assessed by bioeleetrieal impedance. The flow-mediated dilatation（FMD） was measured by ultrasound. Resdts As expected, systolic blood pressure （ SBP）, pulse pressure （ PP）, and extracellular water （ECW） in DN patients were significantly higher than those in non-DN patients（P 〈 0.05 ）, while the FMD was significantly lower in DN patients （ P 〈 0.01 ）. The FMD negatively correlated with the height, body weight, SBP, ECW and ICW （ P 〈 0.05 ）. Finally, in a linear stepwise regression model（ r2 = 0.261, P 〈 0.01 ）, with or without DN （ to be in DN） ,and ECW were all independent predictors of FMD. Conclusions In a cross-sectional analysis of patients in dialysis center, we found a more serious endothelial dysfunction in PD patients with DN. The FMD was associated with volume overload and diabetic status.