糖尿病与腹透液蛋白丢失量对腹膜透析患者心脏结构的影响

目的探讨糖尿病对腹膜透析(PD)患者腹透液蛋白丢失量及心脏结构与功能的影响。方法选择青岛市市立医院肾内科随访的腹膜透析治疗12个月的患者共68例,糖尿病患者32例,非糖尿病患者36例。测定2组患者腹膜透析前后生化指标,24 h腹透液蛋白量,以超声多普勒测定患者腹透前后左心房前后径(LAD)、左心室前后径(LVD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及左心室射血分数(LVEF)等,并进行比较。结果腹膜透析治疗前,糖尿病组与非糖尿病组患者各指标无差异。腹膜透析治疗1年后,两组患者在血清白蛋白、腹透液蛋白丢失量、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及左心室射血分数(LVEF)等指标有统计学差异(P0.05)。腹透液蛋白丢失量:腹透液蛋白丢失量与血浆白蛋白及LVEF呈负相关关系(r=-0.476,P0.01;r=-0.269,P0.05);与IVST、LVPWT呈正相关关系(r=0.461,P0.01;r=0.346,P0.01)。结论糖尿病腹膜透析患者的腹透液蛋白丢失量更大,并会进一步影响患者的心脏结构和功能。

Influences of diabetes and dialysate protein loss on cardiac structure in patients with peritoneal dialysis

Objective To investigate the influences of diabetes and dialysate protein loss on cardiac structure and heart function in patients treated with peritoneal dialysis （PD）. Methods The patients （n=68） treated with PD for 12 m were chosen, and among them 32 with and 36 without diabetes （diabetes group and non-diabetes group）. The biochemical indexes and 24-h dialysate protein quantity were detected in 2 groups before and after PD. The changes of LAD, LVD, IVST, LVPWT and LVEF were detected and compared by using color Doppler ultrasound before and after PD. Results All indexes had no statistical difference in 2 groups before PD. After PD for 1 y, there was difference in serum albumin, dialysate protein loss, IVST, LVPWT and LVEF between 2 groups （P〈0.05）. The correlation analysis showed that dialysate protein loss was negatively correlated to serum albumin and LVEF （r=-0.476, P＆lt;0.01;r=-0.269, P〈0.05）, and positively correlated to IVST and LVPWT （r=0.461, P〈0.01;r=0.346, P〈0.01）. Conclusion Dialysate protein loss will increase in diabetic patients after PD, which can further influence patient’s cardiac structure and heart function.