长期血液透析患者内皮祖细胞的变化及其影响因素分析

目的 检测长期面液透析患者外周血内皮祖细胞数量(EPCs)和功能的改变,并探讨其与微炎症、贫血、高同型半胱氨酸血症各影响因素的关系.方法 采用Ficoll密度梯度离心法分离培养慢性肾功能衰竭长期血液透析患者组和健康组的外周血单个核细胞,将其接种在人纤维连接蛋白包被培养板,7天后取贴壁细胞进行Eli-LDL和FITC-UEA-I双染色,并通过流式细胞仪检测其表面标志CD34、CD133、KDR,以鉴定EPCs.采用改良Boyden小室、黏附功能检测评价其迁移和黏附能力,并与患者血红蛋白(Hb)、血清半胱氨酸(Hey)、C反应蛋白(CRP)含量进行多元线性逐步回归分析.结果 长期血液透析患者EPCs 的数量和迁移、黏附功能都低于正常健康者,差异有统计学意义(P<0.05);患者血清CRP、Hcy含量高于正常对照组(P<0.05),与患者EPcs的数量和迁移、黏附功能分别呈负相关(P<0.05);患者Hb含量低于正常对照组(P<0.05),与患者EPCs的数量和黏附功能分别呈正相关;多元线性逐步回归分析发现血清CRP和Hcy是患者EPCs的数量和功能的独立影响因素.结论 长期血液透析患者的EPCs数量和功能降低,存在血管新生和内皮修复的缺陷,增加了患冠心病的风险,其中血清CRP和Hey是患者EPCs的数量和功能的独立影响因素.     

腹膜透析患者透出液糖类抗原125浓度变化的观察

目的分析腹膜透析透出液糖类抗原125(carbohydrate antigen 125,CA125)浓度在长期腹膜透析过程中的变化,探讨CA125在腹膜透析中的临床意义。方法以2013年1月至2014年12月在陕西省人民医院腹膜透析中心随访的终末期肾脏疾病患者32例为研究对象,其中男15例,女17例;年龄29~64岁,平均年龄为(50.1±16.4)岁。随访期内有7例患者发生过1次腹膜透析相关性腹膜炎。观察持续不卧床腹膜透析患者2年中透出液CA125浓度及腹膜功能的变化;观察仅发生1次腹膜透析相关性腹膜炎患者(7例)透出液中CA125在腹膜炎前、腹膜炎时、腹膜炎治愈后(1个月)的浓度变化;采用微量酶免疫法测定CA125浓度,行腹膜平衡试验评估腹膜转运功能。结果腹膜透析透出液中CA125的浓度呈逐渐递减趋势;0个月时为(17.1±3.1)U/rnl,6个月时为(18.4±3.5)U/ml,12个月时为(16.5±2.4)U/ml,18个月时为(15.6±1.9)U/ml,24个月时为(10.3±2.9)U/ml;而代表腹膜功能的平衡试验中4 h腹透液与血清肌酐的比值(4-hour dialysate-to-plasma creatinine,4h D/Pcr)呈逐渐升高趋势:0个月时为0.57±0.02,6个月时为0.60±0.15,12个月时为0.61±0.16,18个月时为0.62±0.13,24个月时为0.65±0.11。在随访过程中,共发生腹膜炎7例;腹膜炎时CA125浓度明显升高[(34.9±5.8)U/ml],与腹膜炎前CA125浓度[(16.5±2.7)U/ml]及腹膜炎治愈后CA125浓度[(17.4±2.1)U/ml]相比,差异均有统计学意义(P均0.05)。结论随着腹膜透析时间的延长,透出液CA125的浓度有所减少,腹膜转运功能逐渐增加;腹膜炎时,透出液CA125呈短期骤升表现,CA125浓度变化与腹膜炎有相关性。     

大鼠外周血内皮前体细胞体外程序化培养的研究

目的探讨从大鼠外周血中获取内皮前细胞的方法，为缺血性心脏病细胞移植治疗提供新的移植材料。方法首先应用密度梯度离心法分取大鼠外周血中的单个核细胞，然后以IMEM、胎牛血清、马血清、VEGF、bFGF等混合而成的培养基，进行体外培养。最后将此方法收获的细胞经一系列免疫荧光染色，并检测其结合UEA-1、摄取acLDL的能力。结果细胞CD31、CD34、Flk-1和vWF免疫荧光染色阳性，并能结合UEA-1、摄取acLDL。同时结合细胞的形态学变化特点，证实得到的细胞为内皮前细胞。结论通过一定的体外分离、培养途径，可以从大鼠外周血获得较为纯化的内皮前细胞。     

不同年龄腹膜透析患者红细胞体积分布宽度的特点及影响因素

目的近年发现红细胞体积分布宽度(red blood cell distribution width,RDW)与慢性透析患者预后密切相关,本研究旨在探讨腹膜透析患者RDw的特点及其影响因素。方法纳入我院103例行持续性非卧床腹膜透析治疗的尿毒症患者,根据患者开始腹膜透析时的年龄分为3组:年龄40岁组(37例);年龄40~59岁组(47例);年龄≥60岁组(19例)。比较各组腹膜透析前以及腹膜透析1、3个月的临床指标(收缩压、舒张压、体质量指数、RDW、血红蛋白、血白蛋白、血肌酐、血尿素氮等)的差异,采用多元线性回归分析腹膜透析患者的年龄和性别对RDW的影响。结果女性患者中RDW≥14.6%的患者所占比例在基线及腹膜透析1、3个月(13.5%、15.4%、17.3%)均高于男性患者(9.8%、7.8%、13.7%)。≥60岁年龄段的基线RDW较其他两个年龄组显著增高(P0.05)。年龄与基线RDW、腹膜透析1个月的RDW呈正相关(r=0.320、0.242,P0.05)。采用多元线性回归分析,并校正相应体质量指数后分析发现,女性(β=0.025,P0.001,95%CI-0.001~0.953)和年龄较大(β=0.025,P0.001,95%CI 0.010~0.040)的患者基线RDW相对较高,同时年龄与腹膜透析1个月的RDW具有显著相关性(β=0.015,P0.05,95%CI 0.001~0.029)。进一步校正同期血红蛋白、血白蛋白和估算肾小球滤过率(或残肾肾小球滤过率)后发现,年龄与基线RDW(β=0.027,P0.001,95%CI 0.011~0.042)及腹膜透析1个月的RDW(β=0.017,P0.05,95%CI0.003~0.031)仍具有显著相关性。结论 RDW是影响透析患者预后的重要因素;老年是RDW的影响因素,这为改善老年透析患者预后提供了新思路。     

Insulin resistance in non -diabetic peritoneal dialysis patients and its influencing factors

Objective To observe insulin resistance (IR) in non-diabetic peritoneal dialysis (PD) patients, and analyze its related factors. Methods The non-diabetic PD patients who had been on stable PD at least three months were eligible to enroll． The patients were measured for their height, weight, waist to hip ratio, fasting glucose, fasting insulin, lipids and other biochemical indicators, dialysis adequacy indicators in August 2012, and divided into two groups depended on median HOMA-IR in August 2012. Results A total of 56 patients were enrolled and divided into two groups according to median HOMA-IR, including high IR group (HOMA-IR≥1.79, n=29) and low IR group (HOMA-IR＜1.79, n=27). Compared to low IR group, high IR group were older [(57.9±14.2) years vs (48.7±14.5) years], had higher daily dialysate glucose load [(138.7±28.5) mmol/L vs (114.0±21.5) mmol/L], higher waist-to-hip ratio [(0.91±0.08) vs (0.86±0.07)], higher BMI [(23.0±3.0) kg/m2 vs (21.2±3.1) kg/m2], higher triglycerides [(2.51±1.36) mmol/L vs (1.42±0.48) mmol/L], lower high-density lipoprotein cholesterol [(1.00±0.27) mmol/L vs (1.23±0.32) mmol/L], and lower Kt/V [(1.74±0.37) vs (2.08±0.56)]. Multivariate logistic regression showed that age (β =0.122, P=0.033), triglycerides (β = 1.798, P=0.030) and daily dialysate glucose load (β =0.094, P=0.031) associated with the degree of insulin resistance. Conclusion More dialysate glucose exposure is a risk factor of the occurrence of insulin resistance in non-diabetic patients with peritoneal dialysis.     

Changes of serum leptin levels and the influential factors in peritoneal dialysis patients

Objective To investigate the changes of serum leptin levels and the influential factors in maintenance peritoneal dialysis patients. Methods Seventy-six peritoneal dialysis patients were chosen at the time before, and 3 months, 6 months, 12 months, 18 months and 24 months after they began the peritoneal dialysis therapy, to examine body mass index (BMI), triceps skinfold thickness (TSF), abdominal circumference, homeostasis model assessment of insulin resistance (HOMA-IR), the plasma lipid profile, and leptin in the same situation. Results For 24 months, these patients showed higher serum leptin level than the values before commencing peritoneal dialysis treatment (P＜0.01). The level of leptin was positively correlated with the BMI(r＝0.412, P＜0.01), TSF(r＝0.308, P＜0.01), abdominal circumference(r＝0.284, P＜0.01), HOMA-IR(r＝0.184, P＜0.01) and TG(r＝0.288, P＜0.01), negatively corelated with the high-density lipoprotein cholesterol(HDL-C)(r＝-0.285, P＜0.01). Multiple logistic regression analysis showed that BMI (β＝0.339, P＜0.01), TG(β＝0.157, P＜0.01) and HDL (β＝-0.126, P＜0.05)were significant predictive factors for the changes of serum leptin levels. Conclusion Leptin maybe involve in the occurrence and the development of cardiovascular events like other metabolic parameters in peritoneal dialysis therapy.     

Fatigue in chronic peritoneal dialysis patients

Fatigue is a common complaint in long termdialysis patients that may influence theirquality of life. The present study was carriedout in order to evaluate the prevalence andcourse of fatigue in a group of chronic PDpatients and to find the possible factor(s)related to its development. We retrospectivelyreviewed 100 charts of the patients previouslyon PD. The presence or absence of fatigue inthe 1st and last clinic visits and the 1st and2nd changes in fatigue state were studiedaccording to the monthly clinical records ofthe primary nurses. Data regarding dialysatevolume, urine volume, weekly erythropoietin(EPO) dose, hemoglobin, hematocrit, blood urea,serum creatinine, residual renal creatinine andurea clearances, dialysate to peritonealcreatinine ratio (D/P Cr), total weekly Kt/Vand total creatinine clearance/l.73 m² bodysurface area (TCrCl) were collected. Fifty-fivepatients were male and 45 female. The mean ageat the 1st clinic visit was 61.3 ± 16 years.At the 1st visit 55 patients had fatigue and 45did not. In 32 of the 55 patients fatiguedisappeared after a mean duration of 7.9 ± 8.4months and in 31 of the 45 patients fatigueappeared after a mean duration of 8 ± 6.8months. So at the last visit the frequency offatigue increased significantly from 55% to67% (p < 0.001). In patients with fatigue themean age and female percentage were higher(64.2 ± 14.1 vs 57.8 ± 17.6, p = 0.05 and 1.2vs 0.5, p < 0.05 respectively), mean hemoglobinconcentration was lower (104.4 ± 14.7 vs110.6 ± 14.2 g/L, p < 0.04) and mean EPO dosewas higher (6379.6 ± 7142 vs 3395.4 ± 4337.8units/week, p < 0.02) at the 1st clinic visit.EPO dose was also higher in patients withfatigue at the last visit (8253.7 ± 10317.3units/wk vs 4736.4 ± 5432.5, p < 0.03). Nocorrelation was found between dialysis adequacyaccording to either weekly Kt/V or TCrCl andnutritional state according to nPCR andfrequency of fatigue. We conclude that fatigueis a common symptom in PD patients and it'sprevalence increases over time. Anemia seemsto be the most important factor associated withfatigue. Dialysis adequacy and nutritionalstate did not show any correlation with thefrequency of fatigue in our study.     

神经酰胺在葡萄糖腹膜透析液诱导的腹膜间皮细胞凋亡中的作用

目的 观察葡萄糖腹膜透析液(PDS)对人腹膜间皮细胞(PMC)凋亡的影响和细胞内神经酰胺在PMC凋亡中的作用,初步探讨神经酰胺信号通路是否参与高浓度PDS诱导的PMC凋亡.方法 PMC分别在正常对照、1.5％ PDS、4.25％ PDS条件下培养,以4.25％甘露醇作为高渗对照.高压液相色谱串联质谱法(LC-MS-MS)检测细胞内神经酰胺的变化.Annexin - FITC- PI双染流式细胞术检测细胞凋亡.Western印迹法检测bax、p53、bcl-2蛋白表达.结果 (1)PDS可上调PMC细胞内神经酰胺表达,正常对照组、高渗对照组对细胞内神经酰胺均无明显影响.酸性鞘磷脂酶抑制剂地昔帕明可显著抑制高浓度PDS诱导的神经酰胺生成[(56.08±12.24)μg/L比(91.25±15.89) μg/L,P＜0.01].(2)与1.5％ PDS组相比,4.25％PDS可显著诱导PMC细胞凋亡[(26.65±6.21)％比(4.04±1.86)％,P＜0.01],上调bax、p53蛋白表达(P＜0.01),下调bcl-2蛋白表达(P＜0.05).地昔帕明可明显抑制高浓度PDS诱导的PMC细胞凋亡,bax、p53上调以及bcl-2下调(均P＜0.05),外源性神经酰胺则可明显逆转地昔帕明的此类作用(P＜0.05).正常对照组、高渗对照组对细胞内神经酰胺表达及细胞凋亡均无明显影响.结论 细胞内神经酰胺增加可能参与了高浓度PDS诱导的PMC凋亡.     

Ambulatory blood pressure monitoring in paediatric patients treated by regular haemodialysis and peritoneal dialysis

Ambulatory blood pressure monitoring (ABPM) has been shown to be more representive of blood pressure (BP) levels than casual BP measurements in adult patients treated by haemodialysis (HD). In this study we compared ABPM using the oscillometric SpaceLabs 90207 monitor with casual BP measurements in 35 paediatric patients [17 treated by peritoneal dialysis (PD) and 18 by DH]. Heart rate and plasma concentrations of atrial natriuretic peptide were also measured. No correlations were found between ABPM and casual BP measurements, except for systolic day-time BP in PD patients (r=0.63). Seventy percent of PD and 33% of HD patients were regarded as hypertensive when evaluated by ABPM, while casual BP measurements demonstrated hypertension in 47% (P<0.05) of PD patients and in 44% (NS) of HD patients. One-third of patients were reclassified by ABPM either from normotensive to hypertensive (7/19) or from hypertensive to normotensive (5/16). BP assessed by ABPM was higher in PD than in HD patients. The physiological decline of BP at night was significant and more prouounced in PD than in HD patients. In HD patients day-time BP did not differ between the 1st and the 2nd interdialytic day, but increased in the night hours before the following dialysis session. A positive correlation was found between day-time BP and pre-dialysis plasma atrial natriuretic peptide in both treatment groups. In conclusion this study demonstrates that casual BP recordings are not representative of average BP in dialysed paediatric patients. ABPM is useful in the diagnosis and treatment of hypertension in children with endstage renal disease.     

黄芪改善腹透患者腹腔巨噬细胞功能的临床研究

目的：研究黄芪对尿毒症患腹腔巨噬细胞功能的影响。方法：对43例尿毒症初始行腹膜透析的患在腹透液中不加（对照组）和加入黄芪注射液（用药组）治疗1周,用ELISA法检测观察前后腹腔巨噬细胞分泌TNF－a能力和吞噬功能的变化。结果：黄芪用药组腹腔巨噬细胞吞菌率、吞噬指数、杀菌率和巨噬细胞分泌TNF－a水平和对照组相比均明显上升（P＜0．01）,巨噬细胞分泌TNF－a水平与用药前自身对比也显提高（P＜0．05）。结论：腹透液中加入黄芪注射液可提高腹透患腹腔巨噬细胞功能。     

Prevalence and influencing factors of peritoneal calcification in patients with long peritoneal dialysis duration

Objective To investigate the prevalence and related factors of peritoneal calcification in peritoneal dialysis (PD) patients with long dialysis duration, and to explore the relationship between peritoneal calcification and vascular calcification. Methods This cross-section study enrolled PD patients who had received PD for more than 4 years in Peking University People's Hospital. Peritoneal calcification and abdominal aortic calcification were reviewed by CT scan. Demographic data, clinical characteristics, laboratory data including calcium phosphorus metabolism indexes (Ca, P, ALP and iPTH) and PD adequacy were collected. The influencing factors of peritoneal calcification were analyzed by Logistic regression analysis. The correlation between peritoneal calcification and abdominal aortic calcification were tested by Spearman correlation analysis. SPSS 19.0 was used for statistical analysis. Results (1) Seventy-nine PD patients were enrolled: 32 males (40.5%); mean age was (58.7±13.1) years and average PD duration was 77.25(58.00, 88.00) months. The major primary diseases were glomerulonephritis (46.8%) and diabetic nephropathy (30.4%). (2) 6 patients (7.6%) had CT-detectable peritoneal calcification. 77(97.5%) patients were found with various degrees of peritoneal thickening. The prevalence of peritoneal calcification was 7.6% in patients with PD duration more than 4 years, 10.3% in patients with PD duration more than 6 years, 18.8% in patients with PD duration more than 8 years and 40.0% in patients with PD duration more than 10 years, showing an increasing trend. Compared with non-peritoneal calcification group, the patients in peritoneal calcification group received higher doses of Vitamin D (P＜0.001) and lower triglyceride levels (P=0.041). The patients were divided into two groups according to whether dialysis duration was longer than 9 years, and the proportion of patients with long PD duration in peritoneal calcification group was higher (P=0.013). Logistic regression analysis showed that PD duration, calcium and phosphorus metabolism indexes were not independent risk factors of peritoneal calcification. High vitamin D dose was an independent risk factor for peritoneal calcification (B=2.667, OR=14.394, 95%CI 1.655 - 125.165, P=0.016). (3) 74 patients were found with abdominal aortic calcification in different degrees, and the prevalence rate of abdominal aortic calcification was 93.7%. Spearman correlation analysis showed that there was no correlation between peritoneal calcification and vascular calcification (r=0.70, P=0.542). Conclusions The prevalence of peritoneal calcification in long PD duration patients is low. Peritoneal calcification may be associated with high Vitamin D dose and long PD duration.     

Prevalence and risk factors of sarcopenia in peritoneal dialysis patients

Objective To investigate the prevalence and risk factors of sarcopenia in peritoneal dialysis (PD) patients. Methods The patients who underwent regular peritoneal dialysis at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine between November 2016 and March 2018 were enrolled. Handgrip strength (HGS) was measured to assess muscle strength. Bioelectrical impedance spectroscopy (BIS) was applied to measure the lean tissue index (LTI). Reduced LTI plus decreased HGS was defined as sarcopenia. The prevalence of sarcopenia in PD patients was evaluated. According to the presence or absence of sarcopenia, they were divided into the sarcopenia group and the non-sarcopenia group, and the differences in clinical indicators between the two groups were compared. Multivariate logistic regression was used to explore the risk factors of sarcopenia in PD patients. Results A total of 207 patients were enrolled in the study with age of (55.3±13.7) years and a median PD duration of 22.9(7.3, 60.9) months. Of them, 122 patients (58.9%) were male, 45 patients (21.7%) had diabetics and 32 patients (15.5%) suffered from cardiovascular diseases. There were 27 patients (13.0%) diagnosed with sarcopenia. These patients presented with longer PD duration, more prevalent diabetics, lower residual renal function (RRF) and serum pre-albumin, greater ratio of extracellular water to intracellular water (ECW/ICW) and high sensitive C-reactive protein in contrast with those in the non-sarcopenia group (all P＜0.05). Multivariate logistic analysis showed that male (OR=3.94，95%CI 1.35-11.50，P=0.012), longer PD duration (OR=1.01, 95%CI 1.00-1.02，P=0.029) and higher ECW/ICW (OR=1.09, 95%CI 1.05-1.14，P＜0.001) were independent risk factors of sarcopenia in PD patients. Conclusions Sarcopenia is common in PD patients. Male, longer PD duration and higher ECW/ICW were independent risk factors of sarcopenia in PD patients.     

改良腹膜平衡试验在腹膜透析患者中的应用

目的 观察改良腹膜平衡试验(改良PET)在腹膜透析(腹透)患者中的应用,初 步建立改良PET转运参数的参考值,探讨其评估腹膜溶质转运特性的准确性及临床意义。方法 97例腹透患者用高渗腹透液(4．25％葡萄糖)进行改良PET,分别测定4 h透析液肌酐与血肌酐 比值(4h D／Pcr)、计算物质转运面积系数(MTAC)、1 h透析液钠与血钠比值(1h D／PNa+)及记录 净超率量(nUF)。其中有14例患者在1个月内曾行标准腹膜平衡试验(标准PET),其结果与改 良PET进行自身比较。所有患者在研究时及研究前1个月内均无腹膜炎。结果 97例腹透患 者中有90例nUF大于400 ml,这些患者的转运参数经正态分布校正后建立了改良PET的参考 值。改良PET的4 hD／Pcr为0．70±0．15,标准PET4 hD／Pcr为0．68±0．13,两者非常接近,差异 无统计学意义。两种PET对患者腹膜转运特性分型结果相似。7例nUF小于400 ml的患者中有 5例有效腹膜表面积增大;2例存在水通道介导的水转运障碍,其中1例同时存在有效腹膜表面 积增大,还有1例患者改良PET转运参数在正常范围内。结论 与标准PET相比,用高渗腹透 液进行改良PET能够准确地评估腹膜小分子溶质转运特性,此外还能提供更多更敏感的液体转 运信息,为临床诊断超滤衰竭,以及进一步鉴别其原因提供了有力的手段。     

Secretory activity of the coronary artery endothelial cells in conditions of the peritoneal dialysis

IntroductionEndothelial dysfunction is frequent in patients treated with peritoneal dialysis and may lead to cardiac complications. We evaluated the effect of effluent dialysates and serum on the function of coronary artery endothelial cells (CAEC).MethodsHuman CAEC in in vitro culture were exposed to serum and dialysates from 24 patients treated with continuous ambulatory peritoneal dialysis (CAPD) and secretion of interleukin-6 (IL6), von Willebrand factor (vWF), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) were measured. Modulation of the secretory activity of CAEC by Sulodexide, mixture of glycosaminoglycans: heparin sulfate and dermatan sulfate, was studied.ResultsSerum from CAPD patients stimulated synthesis of IL6 (+93%), vWF (+18%), and PAI-1 (+20%) and did not change t-PA secretion in CAEC. Dialysates stimulated secretion of IL6 (+89%), vWF (+29%), and PAI-1 (+31%) and did not change t-PA synthesis. Dialysates collected in 12 patients after 6 months more strongly stimulated synthesis of IL6 (+37%) and PAI-1 (+7%). Sulodexide suppressed the secretory activity of CAEC stimulated by the studied sera: IL6 (–38%), vWF (–19%), t-PA (–13%), and PAI-1 (–12%).ConclusionsSerum and the dialysate from CAPD patients induce inflammatory and prothrombotic reaction in coronary arterial endothelial cells. The general pattern of the observed effects for serum and dialysates was similar but the intensity of the effects was not identical. Sulodexide reduced these effects.     

川芎嗪对慢性腹膜透析大鼠腹膜功能及间皮细胞形态的影响

目的 探讨不同剂量的川芎嗪对高糖透析液作用下慢性大鼠腹膜透析（腹透）模型腹膜间皮细胞的形态和功能的影响及它们之间的关系。方法 ４０只ＳＤ大鼠随机分为４．２５％腹透液（ＨＧ组）、４．２５％腹透液＋４０ｍｇ／Ｌ川芎嗪（ＨＧＬ组）、４．２５％腹透液＋１６０ｍｇ／Ｌ川芎嗪（ＨＧＨ组）、对照组。除对照组外,余３组每天分别腹腔内注入２０ｍｌ含不同剂量川芎嗪的４．２５％透析液［０（ＨＧ）、４０ｍｇ／Ｌ（ＨＧＬ）     

重新评价腹膜平衡试验以确定腹膜透析患者的溶质转运类型

目的 确定由Twardowski提出的腹膜平衡试验（PET）的转运类型评判值是否适合本中心患者。方法 选取我院自1995年来首次进行PET测试的患者158例。首先依据Twardowski的评判标准（值）判断患者的转运类型,再根据本组患者实际4hD/Pcr的χ±s来确定患者的溶质转运类型,然后将患者重新分组:按两种数值均符合高转运为H1组,均符合平均转运为A组,均符合低转运为L1组,部分高转运患者经重新评价后符合平均转运为H2组,部分平均转运患者经重新评价后符合低转运为L2组。通过与临床情况（溶质和水的清除）进行对照,以进一步评价更适合本中心患者的评判标准。结果 按照Twardowski的标准,高转运、高平均转运、低平均转运及低转运患者的比例分别为21.5％、44.9％。27.8％及5.7％。本研究患者群中4hD/Pcr的均值和标准差为0.70和0.14,据此重新评判后,各组的比例分别为14.6％、33.5％、33.5％及18.4％。经与临床结果相对比,L2组对水份的清除能力明显高于A组（P<0.005）,与L1组差别无显著性意义。结论4hD/Pcr在不同的地区和人群中表现出不同的均数和标准差值,因而产生了不同的腹膜转运类型。根据本中心患者人群确定的值更适合本中心患者的临床情况。     

Hyperkalemia in chronic peritoneal dialysis patients

Background. Chronic peritoneal dialysis (PD) patients often develop hypokalemia but less commonly hyperkalemia.Methods. We explored incidence and mechanisms of hyperkalemia in 779 serum samples from 33 patients on PD for 1 − 59 months. Normal serum potassium concentration was defined as 3.5 − 5.1 meq/l.Results. Mean monthly serum potassium concentrations were normal (except for 1 month), but we observed hypokalemia (<3.5 meq/l) in 5% and hyperkalemia (>5.1 meq/l) in 14% of 779 serum samples. Incidence of hyperkalemia did not change over time on PD: Year 1 (15%), Year 2 (11%), Year 3 (19%), Years 4–5 (22%). Hyperkalemia was mostly modest but occasionally extreme [5.2–5.4 meq/l (55%), 5.5–5.7 meq/l (21%), 5.8–6.0 meq/l (10%), >6.0 meq/l (14%)]. Of 31 patients (2 excluded due to brief PD time), 39% displayed hyperkalemia only, 23% displayed hypokalemia only, and the remainder (38%) displayed both or neither. Comparing hypokalemia-only with hyperkalemia-only patients, we found no difference in potassium chloride therapy, medications interrupting the renin-angiotensin system, small-molecule transport status, and renal urea clearance. We compared biochemical parameters from the hypokalemic and hyperkalemic serum samples and observed lower bicarbonate concentrations, higher creatinine concentrations, and higher urea nitrogen concentrations in the hyperkalemic samples (p < 0.001 for each), without difference in glucose concentrations.Conclusion. We observed hyperkalemia 3 times as frequently as hypokalemia in our PD population. High-potassium diet, PD noncompliance, increased muscle mass, potassium shifts, and/or the daytime period without PD might contribute to hyperkalemia.     

腹膜透析患者腹主动脉钙化与外周血淋巴细胞亚群的相关研究

目的 探讨腹膜透析(peritoneal dialysis,PD)患者腹主动脉钙化(abdominal aortic calcification,AAC)与外周血淋巴细胞亚群之间的关系.方法 收集86例PD患者临床资料,腹部侧位平片判断患者发生AAC的程度,并计算腹主动脉钙化积分(AAC score,AACs),依据患...     

Effects of seasonal changes on peritoneal dialysis associated peritonitis in peritoneal dialysis patients

Objectives To investigate the effects of seasonal changes on peritoneal dialysis associated peritonitis (PDAP) in patients on peritoneal dialysis (PD), and to provide evidence for clinical prevention and treatment of PDAP. Methods All episodes of PD-related peritonitis during clinic follow-up in maintenance PD patients from Jan 1st, 2007 to Dec 31st, 2015 in Peking University People's Hospital were reviewed. The incidence of peritonitis, laboratory indexes, pathogens and clinical outcomes in different seasons were recorded and analyzed. One-way ANOVA and chi square test were employed to compare the incidence of PDAP and related data in different seasons, and Pearson correlation was used to analyze correlations between PDAP rate and monthly mean temperature and mean humidity. Results During nine years, a total of 119 PD patients occurred 190 times of peritonitis during home PD. The PDAP rate in summer was the highest, 0.21 episodes/year, followed by spring (0.16 episodes/year) and autumn (0.16 episodes/risk year), but there was no significant difference among peritonitis rates in four seasons. There were significant positive correlation between monthly mean temperature, monthly mean humidity and the peritonitis rate (mean temperature: r=0.828, P＜0.01; mean humidity r=0.657, P＜0.05). (2) As for bacteria, in Summer the PDAP rate caused by Staphylococcus aureus and Coagulase negative staphylococcus (CoNS), and Gram-negative bacteria was higher than that in other seasons, but there was no statistical difference. There were significant positive correlation between monthly mean temperature, mean humidity and the rate of CoNS peritonitis (mean temperature: r=0.704, P＜0.05; mean humidity: r=0.607, P＜0.05). (3) There were no statistical difference among results of PD related peritonitis in different seasons about general situation, clinical manifestation, causes of peritonitis and laboratory index before peritonitis episodes. PD procedure-related problems were the main cause of peritonitis in summer and autumn. (4) The cure rate of all peritonitis was 90%. The highest cure rate was in autumn and winter, while the lowest cure rate was in summer, but no statistical difference. Among the peritonitis episodes with treatment failure, 52.6% occurred in summer. Conclusions There is some correlation between the rate of PDAP and seasons. Higher temperature and higher humidity were significantly correlated with higher peritonitis rate, especially the rate of CoNS peritonitis. The prognosis of PDAP in summer was relatively poor, with higher proportion of hospitalization and lower cure rate.     

178例腹膜透析患者超滤量的相关因素分析

目的腹膜透析(peritoneal dialysis,PD)患者超滤量可受到腹膜功能、尿量、营养状态、透析方式等诸多因素的影响,而且有无残肾功能患者的超滤量显然会受到不同因素的影响,故分析这些因素在超滤中发挥的作用可为控制PD患者体液平衡和改善其生存状况提供参考。方法选择武汉市第一医院符合纳入标准的PD患者178例,以UF的四位数将入选患者分成四组(UF1、UF2、UF3、UF4),再将所有患者按有无残肾功能(residual renal function,RRF)分为2组,有RRF组和无RRF组。收集各项临床资料,并计算残肾Kt/V、残肾肌酐清除率(Ccr)等值。最后将具有统计意义的相关因素与总UF、有RRF组UF、无RRF组UF做多重线性回归,评估各因素在UF中发挥的作用。结果无RRF患者组与UF相关的因素有体质量指数(body/mass index,BMI)(P0.01)和留腹时间(P0.05);有RRF患者组与UF呈正相关的因素有2.5%葡萄糖透析液(P0.01)、腹膜运转功能(D/P值)(P0.05),呈负相关的因素为残肾Kt/V(P0.01)和SGA评分(P0.05)。D/P值随腹膜炎发生次数的增多而逐渐增加。多重线性回归分析发现D/P和2.5%葡萄糖透析液是影响总UF的因素,D/P的影响更大;残肾Kt/V、D/P和2.5%葡萄糖透析液是有RRF者UF的影响因素,残肾Kt/V的影响最大;BMI是无RRF患者UF的独立影响因素。结论 D/P是影响PD患者'UF的主要因素,RRF是有RRF者UF的主要影响因素,BMI是无RRF者UF的独立影响因素。因而保护PD患者的腹膜功能和RRF,监测无RRF患者的体质量,避免其增长或减少过快是合理控制PD患者UF的重要方式。