脂代谢异常对腹膜透析超滤衰竭的影响

目的探讨血脂异常对腹膜透析患者超滤衰竭的影响.方法随机选取124例规律腹膜透析12个月以上的患者,测定患者的白蛋白(ALb)、血红蛋白(Hb)、总胆固醇(T-Ch)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、尿素氮(BUN)、肌酐(Cr)、血糖(Glu)水平,计算残肾功能,记录透析龄,根据患者血脂结果分为血脂异常组和血脂正常组,比较2组腹膜透析超滤衰竭的发生率,并以超滤衰竭与否分组,比较2组的血脂水平、肾功能、Glu、ALB、Hb的差异;结果血脂异常组腹膜透析超滤衰竭的发生率明显高于血脂正常组(P=0.008);超滤衰竭组的透析龄长于超滤正常组(t=7.93,P=0.000);超滤衰竭组的收缩压和舒张压明显高于超滤正常组(t收缩压=7.360,P收缩压=0.000,t舒张压=4.51,P舒张压=0.000);超滤衰竭组的T-Ch、TG水平明显高于超滤衰竭正常组(tT-Ch=3.450,PT-Ch=0.001;tTG=6.760,PTG=0.000),而HDL-C水平明显低于超滤正常组(t=-7.53,P=0.000);血脂异常组低转运水平发生率明显高于血脂正常组(P=0.021);多因素分析显示透析龄长、低水平的HDL为腹膜透析超滤衰竭发生的独立危险因素(P透析龄长=0.034、P低水平的HDL=0.048)结论①腹膜透析患者血脂异常是超滤衰竭发生的原因之一,血脂异常患者腹膜透析超滤衰竭的发生与高TG、T-Ch水平、低HDL-C水平有关;②血脂异常患者腹膜透析超滤衰竭可能是通过降低腹膜转运能力而发生的;③透析龄长、低水平的HDL为腹膜透析超滤衰竭发生的独立危险因素。

The Impact of dyslipidemia on ultrafiltration failure in peritoneal dialysis patients

Objective To explore the impact of dyslipidemia on ultrafiltration failure （UFF） in peritoneal di- alysis patients. Method We randomly recruited 124 patients who treated with peritoneal dialysis regularly for more than 12 months. Their plasma ALB, Hb, total cholesterol （T-C）, Triglyceride （TG）, LDL-cholesterol （LDL- C）, HDL-cholesterol （HDL-C）, BUN, Cr, and glucose （Glu） were measured. Their residual renal function was calculated, and dialysis age was recorded. Patients were divided into dyslipidemia group and normal lipid group. The prevalence of UFF was compared between the two groups. They were then sub-grouped based on the presence or absence of UFF. Lipid profile, renal function, Glu, ALB, and Hb were compared between the two subgroups. Results The prevalence of UFF was significantly higher in dyslipidemia group than in normal lipid group （P=-0.008）. Dialysis age was longer and systolic and diastolic blood pressure were higher in UFF group than in normal filtration group （t=7.93, P=0.000 for dialysis age; t=7.36, P=0.000 for systolic BP; t=4.51, P= 0.000 for diastolic BP）. T-C and TG were significantly higher but HDL-C was significantly lower in UFF group than in normal filtration group （t=-3.45, P=0.001 for T-C; t=-6.76, P=0.000 for TG; t=-7.53, P=0.000 for HDL-C）. The prevalence of lower peritoneal transport was significantly higher in dyslipidemia group than in normal lipid group （P=0.021）. Multivariate regression analysis demonstrated that longer dialysis age and the lower HDL were the independent risk factors for UFF in peritoneal dialysis patients. （P=0.034 and 0.048, respectively）. Conclusion Dyslipidemia was one of causes for UFF in peritoneal dialysis patients. In dyslipidemia patients, the pres- ence of UFF correlated to the higher levels of TG and T-C and the lower level of HDL-C. In dyslipidemia patients, UFF may result from the lower peritoneal transport. Longer dialysis age and lower HDL were the independent risk factors for UFF in peritoneal dialysis patients.