腹膜溶质转运特性对腹膜透析患者营养指标的影响

目的探讨腹膜溶质转运特性对腹膜透析患者营养指标的影响.方法按照腹膜平衡试验(PET)计算结果,将68例稳定的连续性不卧床性腹膜透析(CAPD)患者分为高转运组(37例)和低转运组(31例).检测患者血浆和腹透透出液中的总蛋白、白蛋白及氨基酸量,同步计算蛋白质摄入量(DPI)和蛋白质分解率(nPCR).比较两组营养状态及进行相关因素分析.结果两组的残余肾功能、CAPD治疗时间、每日透析液剂量、超滤量、葡萄糖吸收量、血糖、尿素氮(BUN)、血清肌酐(Scr)和尿素清除指数(Kt/V)比较,差异无显著性意义(均P>0.05).高转运组每日经腹透透出液丢失的总蛋白质和多种氨基酸量显著高于低转运组(均P<0.05);各项营养指标均低于低转运组;两组体重及血清白蛋白比较,差异有显著性意义(均P<0.05).每日经腹透液丢失的Alb量和TAA与D/P4Scr呈正相关关系(均P<0.05).结论腹膜透析高转运患者营养指标较低转运者差,应加强对高转运患者的营养护理和指导;每日透析液量及超滤量能达到TCcr与DPI平衡即可,不宜盲目增加腹透液的剂量、浓度和存留时间,导致过度透析,引起蛋白质和氨基酸经腹透液大量丢失及吸收大量的葡萄糖,加重患者蛋白质缺乏性营养不良.

Influence of Peritoneal Transport Characteristics on Nutritional Status of Peritoneal Dialysis Patients

Objective To explore the influence of peritoneal transport characteristics on nutritional status of peritoneal dialysis patients. Methods According to peritoneal equilibrium test (PET) , 68 stable CAPD patients were divided into high transport group (n=37) and low transport group (n=31). Total protein, albumin and amino acid in plasma and peritoneal effusive dialysate were measured. DPI and nPCR were calculated synchronously. Nutritional status between two groups was compared and related factors were analyzed. Results There were no significant differences in remnant renal function, peritoneal dialysis time, daily dialysis dosage, ultrafiltration volume, glucose absorption, blood glucose, BUN, Scr and Kt/V between two groups. Total protein and multiple amino acids lost from daily effusive dialysate were significantly more in high transport group than those in low transport group, whereas nutritional indexes were poorer in high transport group than those in low transport group, including the significant decrease of body weight and serum albumin. Levels of albumin and amino acid in blood and effusive dialysate were correlated with peritoneal transport characteristics(P<0.05). Conclusion The nutritional status of peritoneal high transport patients is worse as compared to low transport ones. Only elevating the dialysis sufficiency can't improve the nutritional status obviously. Nutritional management and guidance should be strengthened for the CAPD patients.