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.

The effect of serum albumin levels on residual renal function in peritoneal dialysis patients XIA

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.