CAPD患者腹膜电荷屏障与腹膜透析液蛋白质丢失的关系

目的测定持续非卧床腹膜透析（CAPD）患者腹膜电荷屏障,并对原发病为糖尿病肾病（DN）与慢性肾小球肾炎（CGN）的CAPD患者的腹膜电荷屏障以及腹膜透析液蛋白进行比较,进而探讨CAPD患者腹膜电荷屏障与腹膜透析液蛋白丢失的相关性。方法选择32例CAPD患者,收集血清以及腹膜透析液,采用清除法测定胰淀粉酶清除率（Cpam）以及唾液淀粉酶的清除率（Csam）的比值（Cpam/Csam）用以评价腹膜电荷屏障;同时测定腹膜透析液蛋白的丢失量。结果①32例CAPD患者腹膜Cpam/Csam的比值为（6.296±21.514）;腹膜透析液蛋白为（4.14±1.91）g;②CGN组腹膜透析液蛋白显著低于DN组[（4.35±1.88）g比（5.61±0.86）g,P=0.011〈0.05];而CGN组Cpam/Csam的比值显著高于DN组[（9.94±28.35）比（0.68±0.86）,P=0.017〈0.05]。③所有患者Cpam/Csam与腹膜透析液蛋白丢失量之间具有显著负相关,相关系数为-0.584,P〈0.01。而且其自然对数与腹膜透析液蛋白丢失量呈直线负相关。结论CAPD患者腹膜电荷屏障的丢失可增加腹膜透析液蛋白的漏出。

The relationship between peritoneal charge barrier and peritoneal protein loss in continuous ambulatory peritoneal dialysis patients

Objective To investigate the relationship between peritoneal charge barrier and peritoneal protein loss in continuous ambulatory peritoneal dialysis （CAPD） patients, we determined the peritoneal charge barrier and then compared the charge barrier and peritoneal protein loss between CAPD patients with the primary disease of diabetes nephropathy （DN group） and those with the primary disease of chronic glomerulonephritis （CGN group）. Method Blood sample and peritoneal fluid were collected. Peritoneal charge barrier was evaluated by the ratio of clearance of pancreatic isoamylase （Cpam） to clearance of salivary isoamylase （Csam） （Cpam/Csam）. Protein loss in peritoneal fluid was measured as well. Results ①In the 32 CAPD patients we investigated, Cpam/ Csam was 6.296±21.514 and protein in peritoneal fluids was （4.14±1.91）g. ② Protein in peritoneal fluid was higher in DN group than in CGN group [（5.61 ±0.86）g vs （4.35±1.88）g, P ： 0.011], but charge barrier was lower in DN group than in CGN group [（0.68±0.86） vs （9.94±28.35）, P = 0.017]. ③Cpam/Csam was nega-tively correlated with peritoneal protein loss （r =-0.584, P 〈 0.01）, and the natural logarithm of Cpam/Csam was also linearly correlated with the protein loss. Conclusion In CAPD patients, the loss of charge barrier on peritoneum promotes the loss of protein in peritoneal fluid. In these patients, the peritoneal microvascular damage, the decrease of peritoneal charge barrier and the loss of peritoneal protein are proportionately correlated.