不同腹膜溶质转运特性腹膜透析患者营养状况的比较

目的 探讨腹膜转运特性对腹膜透析患者营养状态的影响。方法 按照腹膜平衡试验(PET)计算结果,将82例稳定的CAPD患者分为高转运组和低转运组。检测患者血浆和腹透透出液总蛋白、白蛋白及氨基酸量,同步计算蛋白质摄入量(DPI)和蛋白质分解率(nPCR)。比较两组营养状态及分析相关因素。结果两组的残余肾功能、腹透治疗时间、每日透析液剂量、超滤量、葡萄糖吸收量、血糖、BUN、Scr和Kt／V均无显著性差异。高转运组每日经腹透透出液丢失的总蛋白质和多种氨基酸量明显高于低转运组;各项营养指标均低于低转运组,且体重及血清白蛋白有显著性差异。血中及经腹透透出液丢失的白蛋白和氨基酸量均与转运类型相关。结论 腹膜透析高转运患者营养状态较低转运者差。单纯提高透析充分性并不能明显改善营养状态。要加强对高转运患者的营养管理和指导。

Comparison among different peritoneal transport characteristics in nutritional status of peritoneal dialysis patients

Objective To explore the influence of peritoneal transport characteristics on nutritional status of peritoneal dialysis patients. Methods According to peritoneal equilibrium test (PET), 82 stable CAPD patients were divided into high transport group and low transport group. Total protein, albumin and amino acid in plasma and peritoneal effusive dialysate were measured, meanwhile GPI and nPCR were calculated synchronously. Nutritional status between two groups was compared and correlated factors were analyzed. Results There were no significant differences of remnant renal function, peritoneal dialysis time, daily dialysate dosage, ultrafiltration volume, glucose absorption, blood glucose, BUN, Scr and Kt/V between two groups. Total protein and multiple amino acids lost from daily effusive dialysate were significantly more in high transport group than those in low transport group, whereas nutritional indexes were poorer in high transport group than those in low transport group, including significant decrease of body weight and serum albumin. Levels of albumin and amino acid in blood and effusive dialysate were correlated with peritoneal transport characteristics. Conclusions The nutritional status of peritoneal high transport patients is worse as compared to low transport ones. Only elevating the dialysis sufficiency can not improve the nutritional status obviously. Nutritional management and guidance should be strengthened for the CAPD patients.