腹膜透析初透剂量对患者残余肾功能的影响

目的 探讨腹膜透析（腹透）初透剂量对患者残余肾功能的影响。 方法 追踪观察我院3个月内连续门诊随访的178例开始腹透的患者,测定24 h尿量。根据透析第1、3个月尿量的变化分为少尿组（LU,97例）、尿量减少组（DU,19例）、尿量正常组（NU,62例）,记录并分析其透析剂量、腹透液葡萄糖含量、超滤量、尿素清除指数（Kt/V）、体质量、水肿程度及尿量变化等的相关性。 结果 3组患者的年龄和性别比例差异无统计学意义。透析1个月后,DU组的体质量和水肿程度大于LU和NU组（P < 0.05）;腹透液总入量、腹透液葡萄糖含量、超滤量、残余肾尿素清除指数Kt/V（rKt/V）高于LU组,与NU组差异无统计学意义。透析3个月后,DU组的体质量和水肿程度有所下降（P < 0.05）,但仍高于LU和NU组（P < 0.05）;腹透液总入量、超滤量、尿量下降速度比LU组和NU组高（P < 0.05）;rKt/V 比腹透前显著下降（P < 0.05）。3组的血清白蛋白和tKt/V差异无统计学意义。 结论 开始腹透患者过度超滤可引起残余肾功能下降。对于有一定残余肾功能的患者要注意避免快速或过多超滤。     

高血压对持续腹膜透析患者残肾功能的影响

目的：观察不同血压控制状态对患者的残肾功能以及对临床效果的影响。方法：按照140／90mmHg为界，将患者分为血压控制良好组和血压控制不佳组，比较定期随访中两组残肾功能，秀析充分性指标，营养状况和临床结果的判别。结果：腹膜秀析（腹透）患者中高血压的发生率为94．7％，在54例高血压患者中，78．6％的患者联合使用两种以上的降压药物，血压控制正常者仅22例，血压控制较好的患者残肾功能和充分性保持较好，脑血管事件的发生少，结论：持续高血压会加速腹透患者残肾功能的丢失并增加并发症的产生，血压的控制在腹透阶段和非透析氮质血症阶段同等重要。     

依贝沙坦对维持性腹膜透析患者残存肾功能的保护作用

目的 探讨血管紧张素Ⅱ受体拮抗剂（ARB）依贝沙坦能否延缓腹膜透析患者残存肾功能（RRF）的丢失。 方法 将入选的48例病情稳定的维持性腹膜透析患者随机分为依贝沙坦组和对照组。依贝沙坦组予安博维300 mg/d。所有患者每3个月行残存肾功能测定（eGFR），研究前后检测Kt/V、肌酐清除率（CCL）、血钾、血红蛋白，并记录血压和24 h尿量。 结果 研究结束时，依贝沙坦组和对照组的收缩压和舒张压、血红蛋白、血钾水平差异均无统计学意义；依贝沙坦组CCL[单位：L&#8226;周-1&#8226;(1.73 m2)-1] 高于对照组 （63.0±16.9 比 59.0±14.8，P < 0.05）；两组24 h尿量均减少，但对照组较依贝沙坦组减少明显 [(663±312) 比(885±276) ml/d，P < 0.05]。前6个月两组eGFR都明显下降，而依贝沙坦组更明显，6个月后依贝沙坦组下降变缓，研究结束时依贝沙坦组eGFR较对照组高[（1.68±1.01）比（1.04±0.76）ml/min，P < 0.05]。 结论 长期使用依贝沙坦可以延缓腹透患者的残存肾功能的丢失     

残余肾功能对腹膜透析患者营养状况影响的临床研究

目的：前瞻性观察长期持续性非卧床腹膜透析（CAPD）患的营养状况,探讨残余肾功能对营养状况的影响。方法：采用常规处方透析,留取尿液、腹透液,并抽血检测生化、血脂及蛋白营养指标,计算残余肾功能（RRF）、KT／V值、肌酐清除率（Ccr)、单位透析剂量（PV／S）及蛋白质分解率（PCR）,评估每日蛋白质摄入量（DPI)。结果：RRF与KT／V、Ccr及残余尿量呈正相关,（分别r=0.56、0．83及0．80）,与透析时间、透析超滤量呈负相关（分别r=-0.41、0．33）,与PV／S无关。A组（RRF＜3ml/min)患Ccr、KT／V及血浆前白蛋白（PA）、视黄醇结合蛋白（RBP）、转铁蛋白（Tf)明显低于B组（RRF≥3ml/min),但PCR高于B组。然而,A、B两组间Alb、TG及TC却无明显差别。结论：RRF与腹膜透析充分性密切相关,并影响腹透患的营养状况,根据RRF下降程度及时调整透析剂量及方案,是预防CAPD患营养不良发生的最主要手段。     

小剂量日间非卧床腹膜透析对残肾功能较好的糖尿病终末期肾病患者的疗效

目的　研究小剂量日间非卧床腹膜透析（DAPD）和小剂量持续非卧床腹膜透析（CAPD）对残肾功能较好的糖尿病终末期肾病（ESRD）患者的疗效。 方法 病情稳定、残肾功能较好（rGFR≥5 ml/min,且尿量≥750 ml/d）的40例糖尿病ESRD患者入选。按数字随机法分为小剂量DAPD组20例和小剂量CAPD组20例。DAPD组透析处方为1.5 L或2 L,3次/d,每次留腹3～4 h,夜间干腹。CAPD组透析处方为1.5～2 Ｌ,3次/d,或1.5 L,4次/d,夜间留腹。在研究开始及6个月后,分别计算两组腹膜尿素氮清除率（Kt/V）、残肾Kt/V、每周总Ｋt/V、Ccr、rGFR等指标;测定24 h尿蛋白量、24 h腹透液蛋白、血清白蛋白、空腹血糖、糖化血红蛋白及胰岛素剂量;用改良主观综合性营养评估法（SGA）评估患者营养状况。 结果 共35例患者完成研究。两组患者年龄、性别、体质量指数、透析龄、透析液肌酐/血肌酐（D/Pcr）等基线值差异无统计学意义。6个月后,CAPD组胰岛素剂量和24 h腹透液丢失蛋白明显高于DAPD组,分别为（33.6±10.9） U/d 比（20.6±6.2） U/d（P < 0.05）和（11.13±4.95） g比（5.66±2.88） g（P < 0.01）,而血清白蛋白明显低于DAPD组[（29.7±4.2） 比（36.5±3.9） g/L,P < 0.05]。DAPD组与CAPD组相比,24 h净超滤量为（554±187） ml比（309±177） ml,24 h尿量为（1090±361） ml比（750±258） ml,rGFR为（8.21±2.40） ml/min比（4.88±2.11） ml/min,DAPD组均显著高于CAPD组（均P < 0.05）。 结论 对于残肾功能较好的糖尿病ESRD患者,小剂量DAPD较小剂量CAPD能更好地控制血糖,改善营养状态及保护残肾功能。     

血清白蛋白水平对腹膜透析患者残余肾功能的影响

目的 研究血清白蛋白水平对腹膜透析患者残余肾功能的影响.方法 54例腹膜透析患者以血清白蛋白35 g/L为界,血清白蛋白≥35 g/L为A组,血清白蛋白<35 g/L为B组,测定血清白蛋白、血肌酐、血尿素氮,白细胞介素6、肿瘤坏死因α,留取24 h尿量及腹透液、记录总量并检测尿素氮、肌酐;残余肾功能等.随访过程中观察以上指标和残余.肾功能(RRF).结果 B组中糖尿病肾病患者的比例高于A组,相关分析结果显示血清白蛋白水平与炎症介质白细胞介素6及肿瘤坏死因α水平呈负相关(r分别=-0.48、-0.64,P均<0.05),随着透析时间的延长两组患者RRF均下降,而B组RRF自腹膜透析6个月时即开始下降,与透析初月比较差异有统计学意义(P<0.05),12个月时A组RRF与透析初月时比较差异有统计学意义(P<0.05),A、B组RRF比较差异也有统计学意义(P<0.05).相关分析结果显示残余肾功能下降绝对值(△RRF)与血清白蛋白水平呈负相关(r=-0.31,P<0.05),与白细胞介素6及肿瘤坏死因α水平呈正相关(r分别=0.45、0.58,P均<0.01).结论 营养不良导致低水平的血清白蛋白是促进腹膜透析患者残余肾功能下降的因素之一,高水平的炎症介质也加速了残余肾功能的恶化.     

腹膜透析患者残余肾功能与左心室质量的相关性分析

目的探讨腹膜透析患者残余肾功能与左心室质量及左心室质量指数的关系。方法选取我院接受持续不卧床腹膜透析治疗半年以上的慢性肾衰竭患者103例,将其根据残余肾肌酐清除率（Ccr）水平分为3组,A组31例：Cer为0～2ml·min-1·（1．73m2）-1;B组42例：Cer为2～4ml·min-1·（1．73m2）;C组30例：Ccr〉4ml·min-1·（1．73m2）-1。所有入选患者均检测残余肾Ccr、平均动脉压（MBP）、血钙、血磷、血清全段甲状旁腺素（iPTH）、左心室质量及左心室质量指数,并进行组间统计学分析。结果3组患者MBP和血钙水平差异无统计学意义（P〉0．05）;与A组相比,B组和C组患者血磷、钙磷乘积、iPTH、左心室质量及左心室质量指数降低（P〈0．01）;Pearson相关分析显示,Ccr与血磷（r=-0．384,P=0．000）、钙磷乘积（r=-0．344,P=0．000）及iPTH（r=-0．435,P=0．000）存在负相关关系;左心室质量及左心室质量指数与MBP（r=0．300,P=0．002;r=0．240,P=0．015）、血磷（r=0．332,P=0．001;r=0．241,P=0．014）、钙磷乘积（r=0．284,P=0．004;r=0．212,P=0．032）、iPTH（r=0．266,P=0．007;r=0．226,P=0．021）存在正相关关系。结论左心室质量及左心室质量指数增加与残余肾功能的丧失有一定的相关性,积极保护残余肾功能可以减少心血管疾病发生率和病死率。     

缬沙坦对持续性不卧床腹膜透析者腹膜功能的影响

目的 探讨血管紧张素受体拮抗剂缬沙坦对长期腹膜透析者腹膜功能的影响.方法 选择在焦作市人民医院接受腹膜透析者51例,采用数字表法随机分为缬沙坦组（n=28）和对照组（n=23）,对照组未服用血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂类药物.观测并比较基线及1年后估计肾小球滤过率,行腹膜平衡实验,检测超滤量、透析液/血清肌酐（4 h）比值、透析液/葡萄糖浓度（4 h）比值.采用ELISA法检测隔夜腹膜透析液中转化生长因子β1以及血管内皮生长因子的含量.采用t检验进行数据统计.结果 基线时,两组患者临床资料差异无统计学意义（P＞0.05）.1年时,缬沙坦组与对照组估计肾小球滤过率均下降,分别为（3.1±1.8）、（2.1±1.9） ml/min,但对照组下降更为明显,与缬沙坦组比较差异有统计学意义（P＜0.05）.两组透析液/血清肌酐比值、透析液葡萄糖浓度比值差异无统计学意义,对照组超滤量增加更为明显,两组比较差异有统计学意义[对照组：基线时（351±210）ml/4 h,1年时（445±209） ml/4 h;缬沙坦组：基线时（336±198）ml/4 h,1年时（391±220）ml/4 h;P＜0.05].干预后,对照组转化生长因子β1和血管内皮生长因子的表达明显增加,与基线比较差异有统计学意义（P＜0.05）,而缬沙坦组干预前后转化生长因子β1和血管内皮生长因子的表达差异无统计学意义.结论 血管紧张素受体拮抗剂缬沙坦对腹膜透析者残余肾功能具有保护作用,可延缓腹膜透析者超滤衰竭的发生,抑制腹透液中腹膜纤维化相关因子的表达,进而抑制、延缓腹膜纤维化的发生和发展,保护腹膜功能.     

Validation of cystatin C-based equations for evaluation of residual renal function among patients undergoing continuous ambulatory peritoneal dialysis

Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function （RRF） in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods Fifty patients on CAPD from our department were enrolled in the study. Eight patients with residual urine volume ≤100 ml/d and 42 patients with residual urine volume ＞100 ml/d were enrolled into anuria group and non-anuric group respectively. The clinical and laboratory status of each group were compared and equations (Hoek’s, Yang’s and abbreviated MDRD equations) were validated in the non-anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF. Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46±1.15) mg/L, t＝2.39, P＝0.02)]. (2) RRF estimated by each equation was correlated well with measured RRF (r＝0.56, 0.56 and 0.39, all P＜0.05). (3) Yang’s equation [0.10 ml•min-1•(1.73 m2)-1] was least biased, followed by Hoek’s equation [-0.73 ml•min-1•(1.73 m2)-1] and abbreviated MDRD equation [3.15 ml•min-1•(1.73 m2)-1]. (4) The precision of Yang’s equation was equivalent to that of Hoek’s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml•min-1•(1.73 m2)-1]. (5) 50% accuracy according to Yang’s equation and Hoek’s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5% and 54.8% vs 23.8%, respectively, all P＜0.01). Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias, precision and 50% accuracy. For patients undergoing CAPD, the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.     

血清白蛋白水平对腹膜透析患者残余肾功能的影响

Objective To study the effect of serum albumin(Alb) levels on residual renal function (RRF) in peritoneal dialysis patients. Methods Fiftyfour patients accepting peritoneal dialysis were divided into two groups base- d on the serum levels of Alb,including group A (Alb≥35 g/L) and group B(Alb < 35g/L). The serum levels of Alb, creatinine, urea nitrogen, IL-6, TNFα were determined. 24 - hour urine and peritoneal dialysis fluids were remained and urea nitrogen, creatinine, RRF, and others were determined. The above mentioned marks and RRF were observed in follow- up visit. Results The proportion of diabetic nephropathy patients in group B was higher than in group A. Correlative analysis indicated that a negative correlation was found between the levels of Alb and mediators of inflammation IL - 6 and TNF - α. The de-crease in RRF is time- dependent in all selected patients. But the RRF in group B began to decline since peritoneal dialysis 6th month, there is lower compared with 1st month. After peritoneal dialysis 12th months the RRF in group A also significant declined, but the degree of declining in group B was greater. Correlative analysis indicated that the negative correlation was found between RRF and the levels of Alb, otherwise the positive correhtion was found between the RRF and mediators of inflammation IL - 6 and TNF - α. Conclusions The low levels of Alia resulted from malnutrition was one of the factors to decline RRF in per-itoneal dialysis patients. The high levels of mediators of inflammation accelerated the deterioration of the RRF.     

血液透析和腹膜透析患者生存质量的多中心调查

目的评估我国广东省南部血液透析(血透)和腹膜透析(腹透)患者生存质量的状况;比较血透和腹透患者生存质量差异;探讨影响血透和腹透患者生存质量的基本因素.方法采取多中心研究方法.病例选自广东省南部,而主要是广州市的9家大医院的维持性血透、腹透3个月以上的患者,其中血透180例,腹透122例.使用KDQOL-SFTM表进行问卷调查,根据Hays RD提供的方法进行评分.结果 (1)血透患者肾脏病和透析相关生存质量(KDTA)总分为51.2±10.6,SF-36总分为48.2±19.9;腹透患者KDTA总分为56.3±12.3,SF-36总分为47.8±16.8.血透多数领域评分较欧美日同类报道为低;腹透仅部分领域低于香港特别行政区,但总体评分与香港特别行政区同类报道无显著差异.(2)比较研究提示腹透总体评分高于血透,但进一步的分层研究提示血透与腹透的生存质量差异主要是在透析的前2年.(3)血透男性患者在KDTA和SF-36及其它5个领域优于血透女性患者;而腹透男女患者之间KDTA和SF-36总分无显著差异.无论男女,腹透患者在多个领域均优于同性别血透患者.(4)血透患者的青年组(＜45岁)与中年组(45～60岁)、老年组(＞60岁)相比,在KDTA和SF-36总体水平无显著差异,仅在体能相关领域高于中老年组.腹透患者青年组在KDTA和SF-36总分以及多个分支领域明显高于中老年组患者,同时,腹透患者在不同年龄组的多个领域优于同年龄段血透患者.(5)在生存质量的总体变化趋势方面,血透患者初始的生存质量较低,透析1～2年时的生存质量逐渐提高,2～4年处于高峰,以后开始下降;腹透患者生存质量的趋势KDTA比较平稳,但2年后SF-36呈明显下降趋势.(6)多元回归分析提示,对KDTA和SF-36总体生存质量的影响因素分别为透析方式、年龄、性别和透析时间.结论 (1)广东省南部,而主要是广州市的血透和腹透患者生存质量状况的总体水平仍低于西方国家和香港特别行政区.(2)慢性肾衰竭患者一体化治疗的前2年可首选腹透.(3)血透和腹透患者的KDTA和SF-36生存质量的趋势不同,腹透不仅适合老年患者,更适合年轻患者和女性患者.(4)透析方式、透析时间、性别和年龄影响透析患者的生存质量,但影响程度和领域各不相同.     

Association of fetuin A,left ventricular function and residual renal function in peritoneal dialysis patients

Objective To investigate the relationship between fetuin A and left ventricular function and their influences on residual renal function(RRF) in peritoneal dialysis patients. Method Eighty patients recently initiating peritoneal dialysis were enrolled into this study and were divided into high fetuin A group and low fetuin A group accordin to the value of serum fetuin A concentration. Hemoglobin, high sensitive C reactive protein(hsCRP), calcium, phosphorus, albumin, lipoproteins and left ventricular myocardial performance index(LV-MPI) were examined. All these patients were followed up for 12 months, to discover the parameters’ differences between two groups and to investigate the association between fetuin A and left ventricular function and RRF. Results At the beginning of the study, there was no difference of hsCRP, calcium, phosphorus, albumin, lipoproteins and LV-MPI, estimated glomerular filtration rate (eGFR) between two groups; After 12 months follow-up, MPI was obviously shorter (P＜0.05) and RRF was obviously higher (P＜0.05) in high fetuin A group than thosein low fetuin A group. Compared with the beginning of the study, LV-MPI was significantly increased and eGFR was significantly decreased after 12 months follow-up (both P＜0.05) in low fetuin A group, but no obviously change of LV-MPI or eGFR was found in high fetuin A group after follow-up. Pearson correlation analysis discovered an obvious negative correlation between fetuin A and MPI (r=-0.680, P＜0.01). Multiple regression analysis indicated that eGFR had positive correlation with fetuin A (B=0.058, t=3.679, P＜0.01) and negative correlations with MPI (B=-0.511, t=-2.903, P=0.007), age(B=-0.144, t=-4.013, P＜0.01). Diabetes was risk factor to loss of RRF (B=-2.031, t=-2.759, P＜0.05). Conclusion Fetuin A has very close relationship with left ventricular function.Decreased serum fetuin A level and decreased left ventricular function are risk factors to the loss of the RRF in ERSD patients.     

Residual renal function in children on haemodialysis and peritoneal dialysis therapy

Residual renal function was studied in 28 haemodialysis (HD) and 31 peritoneal dialysis (PD) patients aged 1–20 years observed over 6–43 (median 19) months. After the start of dialysis urine volume (UV) decreased to 57%, 46% and 26% of initial mean values in HD patients after 6, 12 and 24 months, respectively. In PD patients the corresponding figures were 57%, 69% and 62%. Mean UV calculated from all individual mean UV measurements observed was higher in PD than HD patients (954 vs. 537 ml/m² per 24 h,P<0.01). A better conservation of diuresis in PD patients was also suggested by a significantly longer persistence of a UV greater than 500 ml/m² per 24 h compared with HD patients. Cox proportional hazard analysis identified dialysis modality and pre-dialysis UV of less than 1,000 ml/m² per 24 h as the only significant risk factors for UV survival. However, the decline of UV per time was similar in both modes of treatment. No significant changes of glomerular filtration rate were observed during both HD and PD treatment.     

腹膜透析剂量与残余肾功能及透析质量的关系研究

目的观察慢性肾脏病5期患者应用非透析治疗、不同腹膜透析剂量治疗对肾功能的影响。方法选取慢性肾脏病5期的非糖尿病肾病患者,采用非透析保守治疗者20例,腹膜透析剂量4升／天者26例、6升／天者35例及8升／天者43例。随访观察1年,检查各项指标及肾功能的变化。结果随访1年后,非透析患者血压的控制较4升／天腹膜透析组差（P〈0．05）,血清白蛋白水平、血钙水平低于4升／天透析组,血磷及甲状旁腺素水平高于不同剂量透析组。各组尿量及残余肾功能均有不同程度的下降,其中腹膜透析各组尿量、肾功能及非透析组肾功能均较观察前具有统计学差异（P〈0．05）,而各组之间肾功能下降的幅度未见显著性差异（P〉0．05）。结论慢性肾脏病5期患者早期的腹膜透析治疗对患者钙磷代谢、蛋白质营养改善及血压的控制优于非透析治疗。腹膜透析治疗对残余肾功能的保护与非透析治疗相比未见明显优势,不同的透析剂量在1年的观察期内未显示对肾功能的影响。     

The status on achieving Kt/Vurea target and its relation with residual renal function and clinical characteristics of peritoneal dialysis patients

ObjectiveTo explore the present status on achieving Kt/Vurea target in Chinese peritoneal dialysis (PD) patients and its relation with residual renal function (RRF) and clinical characteristics. Methods This was a cross-sectional study carried out in 5 PD centers in different area of China. Totally 681 clinical stable PD patients with duration≥3 months who completed dialysis adequacy and biochemical test during April 1st, 2011 and August 31st, 2011 were enrolled in this study. The demographic data and clinical characteristics were compared according to varied Kt/Vurea and RRF levels. Results (1)The total Kt/Vurea was 1.95±0.59,and total Ccr was （63.80±30.84）L·week-1·(1.73 m2) -1 for the whole group, there were 67.4% subjects achieving the Kt/Vurea target. (2) Patients achieving Kt/Vurea targetwere prone to be female and had smaller size with higher RRF and urine volume (P＜0.05). The serum calcium and phosphorus were controlled well in these patients (P＜0.05). They also had better higher cholesterol and low-density lipoprotein, and lower CRP level and less complications (P＜0.05). (3)Serum albumin was higher but inflammation and complications were less in patients with Kt/Vurea value≥1.7 and RRF≥2 ml·min-1·（1.73 m2）-1 (subgroup 1), as compared to those with Kt/Vurea≥1.7 but RRF＜2 ml·min-1·（1.73 m2）-1 (subgroup 2) and those with Kt/Vurea＜1.7(subgroup 3) (P＜0.05). The subgroup 2 and 3 were statistically different in these clinical indices, serum calcium [(2.22±0.21) mmol/L vs (2.14±0.24) mmol/L, P＜0.01], serum phosphorous [(1.43±0.47) mmol/L vs (1.66±0.52) mmol/L, P＜0.01], cholesterol [(4.91±1.29) mmol/L vs (4.62±0.99) mmol/L, P＜0.05], low-density lipoprotein [(2.86±0.96) mmol/L vs (1.13±0.61) mmol/L, P＜0.01], high-density lipoprotein [(1.08±0.33) mmol/L vs (2.20±0.72) mmol/L, P＜0.01]. (4)The Kt/Vurea was positively correlated with RRF (R2＝0.317); if RRF decreased 1 ml/min, the hazard of Kt/Vurea un-targeting increased 40.3%. Conclusions About 67.4% of PD patients can reach the Kt/Vurea target recommended by K/DOQI. RRF makes a great contribution to Kt/Vurea target. The clinical characteristics are poorer in patients who can not achieve the Kt/Vurea target, or with worse RRF.     

腹膜透析患者不同透析剂量临床疗效比较

目的 比较腹膜透析患者不同透析剂量的临床疗效.方法 横断面调查西安交通大学医学院第一附属医院腹膜透析中心透析超过3个月但处于稳定状态的腹膜透析患者,根据透析剂量不同分为3组,A组≤4000ml,B组≤6000ml,C组≥8000ml.比较3组患者的透析充分性、血浆白蛋白、校正的蛋白分解率、24 h腹透液蛋白定量、体表面积、用尿尿素氮清除率与尿肌酐清除率的均值计算肾小球滤过率.结果 3组患者总尿素氮清除指数和总肌酐清除率比较差异无统计学意义(P>0.05);A组患者腹膜Kt/V和腹膜总肌酐清除率与B、C组比较差异有统计学意义(P<0.01);c组患者残肾Kt/V和残肾总肌酐清除率及肾小球滤过率与A、B组比较差异有统计学意义(P<0.01);A组患者白蛋白与C组比较差异有统计学意义(P<0.15);3组间蛋白分解率比较差异无统计学意义(P>0.05).A组患者24 h腹透液蛋白定量与C组比较差异有统计学意义(P<0.05).A组患者体表面积与B、C组比较差异有统计学意义(P<0.0).A组患者促红素用量及医药费用最低.结论 (1)大多数患者使用6000 ml或6000 ml以下的透析剂量可以达到充分透析;(2)残肾功能好,体表面积小的患者,小剂量透析可以维持良好的营养状况,医疗费用越低;(3)透析时间长、残肾差、体表面积大的患者需要更高透析剂量才能维持充分透析,但腹膜透析液蛋白丢失增多,蛋白摄入不足,残肾对毒素清除减少可能使营养状况恶化.     

非医疗因素对长期腹膜透析患者生存质量的影响

目的研究可能影响长期腹膜透析患者生存质量的非医疗因素,旨在为临床工作中如何提高患者的生存质量提供依据。方法采用横断面研究方法调查79例慢性肾衰竭进行持续非卧床腹膜透析（CAPD）患者。记录患者的年龄、性别、工作状况、文化程度、医疗负担及家庭支持等情况。采用国际通用的KDQOL-SFTM1．2中的短表SF-36评估患者的生存质量。采用汉密尔顿焦虑抑郁量表评估患者的焦虑、抑郁指数。结果SF-36评估患者的生存质量提示：CAPD患者生存质量的8个方面得分均显著低于中国一般人群（P〈0．05或〈0．01）;在职患者和有医疗保障患者sF-36得分分别为（45．78±16．93）分和（49．62±13．20）分,明显高于非在职患者的（32．65±12．26）分和无医疗保障患者的（33．85±6．24）分（P〈0．05）;人均年收入越高的家庭,患者生存质量就越高;有子女和老伴共同照顾的患者生存质量最高,而由保姆或个人照顾的患者生存质量最低;79例患者中焦虑的发生率为54．4％（43/79）,抑郁的发生率为15．2％（12/79）,二者均与生存质量呈显著负相关。结论家庭支持、工作状况、医疗保障和心理障碍均对CAPD患者的生存质量产生重要影响。     

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。     

Correlation of serum hepcidin with residual renal function and micro-inflammation in peritoneal dialysis patients

Objective To study the correlation of serum hepcidin with residual renal function and micro-inflammation state in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Thirty-four stable CADP patients were involved in this study as observers (CAPD group), who had accepted CAPD treatment more than three months; twenty non-dialysis patients with stage 5 of chronic kidney disease were selected as control group. According to the level of high sensitivity Creactive protein (hs-CRP), CAPD patients were divided into two subgroups. There were 14 patients in the hs-CRP elevated group (hs-CRP＞3.00 mg/L) and 20 patients in the hs-CRP normal group. In addition, there had been 14 patients with residual renal function in CAPD group. Serum hepcidin was measured by ELISA. Serum Ferritin (FER), hs-CRP, routine blood and biochemistry were measured by routine methods. Calculated estimated glomerular filtration rate (eGFR). Pearson correlation and linear regression were used to assess the correlation of serum hepcidin with other laboratory parameters in CAPD patients. Results (1) Serum hepcidin was significantly higher in CAPD patients than control group, but eGFR was significantly lower (P﹤0.01). (2) Serum hepcidin levels of no residual renal function patients increased more significantly in CAPD group (P﹤0.05). (3) Serum hepcidin levels were higher in hs-CRP elevated group than hs-CRP normal group (P﹤0.05). (4) Pearson correlation analyses revealed that serum hepcidin was positively correlated with hs-CRP (r=0.501) and FER (r=0.847, all P﹤0.01), and was negatively correlated with Hb (r=-0.919), TRF (r=-0.751), TIBC (r=-0.532, all P＜0.05). (5) Multiple linear regression analysis showed that ferritin and hs-CRP were closely associated with serum hepcidin level in CAPD. Conclusions Serum hepcidin level markedly elevate in CAPD patients, especially in the patients with no residual renal function and micro inflammatory state increased more significantly.     

透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响

目的探讨透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响。方法本院维持性血液透析患者114例入选。检测指标包括（1）整体营养状况：使用MQSGA评估表并测定血清胰岛素样生长因子（IGF）1、胰岛素样生长因子结合蛋白3（IGFBP-3）、Hb、Alb。（2）人体指数学测定。（3）血液透析充分性：测定血清iPTH、β2-MG、BUN并计算Kt／V、nPCR。（4）残存肾功能：测量患者24h尿量。（5）微炎症：测定血清CRP、IL-6、TNF-α。结果（1）Kt／V、iPTH、β2-MG分别与测量握力（HGS）、上臂中部肌肉周径（MAMC）、无骨上臂肌肉面积（AMA）、Alb、Hb、nPCR、IGF-1相结合，MQSGA呈不同程度的相关和回归关系。（2）残存尿量在血透第1年内，与HGS、肱三头肌皮褶（TSF）、MAMC、Alb、nPCR、IGF-1呈显著相关和回归关系。（3）IL-6、TNF-α、CRP分别与HGS、MAMC、AMA、Alb、TSF、Hb、nPCR、IGF-1呈不同程度的相关和回归关系。（4）影响血透患者营养状况的因素分别是Kt／V、iPTH、IL-6、TNF—α、β2-MG、残存尿量，其中Kt／V、iFFH、IL-6、TNF—α是独立影响因素。结论血液透析中小分子毒素的透析不充分，微炎症可能是患者营养不良的关键因素之一。残存肾功能可能在透析第1年内对营养状况有显著影响。在上述诸因素中。Kt／V、iPTH、IL-6、TNF-α是影响营养状态的独立因素。