早期低剂量腹膜透析对尿毒症患者残存肾功能的保护及微炎症状态的影响

目的 探讨早期低剂量腹膜透析对尿毒症患者残存肾功能的保护及微炎症状态的影响.方法 将2008年3月至2011年2月收治的68例慢性肾功能衰竭患者分为两组,其中腹透组34例,接受常规药物治疗,并给予间歇性腹膜透析,每日4000～6000 ml,每周4～5 d;对照组34例,只接受常规药物治疗.所有患者每3个月行残存肾功能测定(RRF)及C-反应蛋白(CRP)检测,研究前后检测肌酐清除率(Ccr)、血钾、血红蛋白,并记录血压和24 h尿量.结果 研究结束时,早期低剂量腹膜透析组和对照组的收缩压、舒张压、血红蛋白、血钾水平差异均无统计学意义;腹透组Ccr高于对照组,但对照组较腹透组减少明显(P<0.05).前6个月两组RRF的明显下降,6个月后腹透组下降变缓,研究结束时腹透组RRF较对照组高(P<0.05).而从第3个月时腹透组CRP较对照组高(P<0.05).结论 早期使用低剂量腹膜透析可以延缓尿毒症患者残存肾功能的丢失及降低尿毒症患者微炎症状态.

Effect of early low-dosage peritoneal dialysis on residual renal function and microinflammation in uremic patients

Objective To investigate whether early low-dosage peritoneal dialysis can slow the decline of residual renal function(RRF) and improve microinflammation in patients with end-stage renal failure(ESRD) treated.Methods Sixty-eight ESRD patients from March 2008 to February 2011 were randomly divided into two groups.Patients in PD group(n=34) were treated with routine medication companied by intermittent peritoneal dialysis at dosage of 4000-6000 ml/day in 4~5 days per week.Patients in control group(n=34) only received routine medication treatments.RRF and CRP were detected every 3 months in all the patients.Ccr,K+,Hb were detected and BP,24 h urine volume were recorded before and after the study.Results At the end of the study,SBP,DBP,the level of Hb and K+ had no significance difference between the two groups.Ccr in the PD group was higher than that in the control group,but it decreased significantly in the control group than that in the PD group.RRF were decreased in the two groups duing the first 6 months.After 6 months,RRF was decreased slowly,and RRF in the PD group was higher than that in the control group at the end of the study(P<0.05).From the 3 months,the levels of CRP in the PD group were higher than that in the control group(P<0.05). Conclusion Early low-dosage peritoneal dialysis may reduce the rate of decline of residual renal function and improve microinflammation in uremic patients.