血液透析与腹膜透析对终末期肾病患者血脂、氧化应激及炎症因子的影响

目的分析血液透析与腹膜透析对终末期肾病(ESRD)患者血脂、氧化应激及炎症因子的影响。方法选取2016年1月至2018年1月我院收治的终末期肾病患者200例为研究对象,采用随机数字表法将其分为观察组、对照组各100例,对照组予以血液透析治疗,观察组实施腹膜透析治疗,比较两组治疗前后血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)]、氧化应激指标[丙二醛(MDA)、髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)]、炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]水平、生存质量[健康状况调查简表(SF-36)]及并发症的情况。结果治疗后观察组血清TC、TG、HDL-C、LDL-C水平明显低于对照组(P <0.05);治疗后观察组血清MDA、MPO、hs-CRP、TNF-α、IL-6水平低于对照组,而SOD水平高于对照组(P <0.05);治疗3个月、治疗6个月观察组SF-36评分高于对照组(P <0.05);观察组治疗期间并发症发生率12.0%低于对照组24. 0%(P <0.05)。结论与血液透析相比,腹膜透析治疗ESRD疗效更好,可明显改善患者血脂、氧化应激及炎症因子水平,提高其生活质量,减少并发症,值得在临床推广实践。     

Overhydration Negatively Affects Quality of Life in Peritoneal Dialysis Patients: Evidence from a Prospective Observational Study

Backgound: This study evaluated whether the hydration status affected health-related quality of life (HRQOL) during 12 months in peritoneal dialysis (PD) patients.Methods: The hydration status and the HRQOL were examined at baseline and after 12 months using a bioimpedance spectroscopy and Kidney Disease Quality of Life-Short Form, respectively in PD patients. Four hundred eighty-one patients were included and divided according to the baseline overhydration (OH) value; normohydration group (NH group, -2L≤ OH ≤+2L, n=266) and overhydration group (OH group, OH >+2L, n=215). Baseline HRQOL scores were compared between the two groups. The subjects were re-stratified into quartiles according to the OH difference (OH value at baseline - OH value at 12 months; <-1, -1 - -0.1, -0.1 - +1, and ≥+1L). The relations of OH difference with HRQOL scores at 12 months and the association of OH difference with the HRQOL score difference (HRQOL score at baseline - HRQOL score at 12 months) were assessed.Results: The OH group showed significantly lower baseline physical and mental health scores (PCS and MCS), and kidney disease component scores (KDCS) compared with the NH group (all, P<0.01). At 12 months, the adjusted PCS, MCS, and KDCS significantly increased as the OH difference quartiles increased (P<0.001, P=0.002, P<0.001, respectively). In multivariate analysis, the OH difference was independently associated with higher PCS (β = 2.04, P< .001), MCS (β=1.02, P=0.002), and KDCS (β=1.06, P<0.001) at 12 months. The OH difference was independently associated with the PCS difference (β = -1.81, P<0.001), MCS difference (β=-0.92, P=0.01), and KDCS difference (β=-0.90, P=0.001).Conclusion: The hydration status was associated with HRQOL and increased hydration status negatively affected HRQOL after 12 months in PD patients.