残余肾功能对腹膜透析患者心血管系统的影响

目的:观察不同残余肾功能(RRF)对腹膜透析(PD)患者心血管系统的影响. 方法:根据PD患者随访过程中残余肾小球滤过率(rGFR)水平将其分为A组(GFR 0～2 ml/min)、B组GFR(2.1～4 ml/min)、C组GFR(4.1～6.0 ml/min)和D组(>6.0 ml/min).每3个月对患者进行一次临床随访,全面评估患者的伞身情况及透析状态,包括血浆白蛋白(AIb)、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、尿量(UV)、残余肾肌酐清除率(Ccr)、每周总尿素氮清除率(Kt/V total)、每周肌酐总清除率(WCcr total)、蛋白氮呈现率(nPNA)、心脏超声和胸部平片. 结果:四组不同RRF患者Kt/v total分别为1.66±0.42、1.85±0.40、2.11±0.45、2.60±0.69(P<0.01);四组间心胸比分别为0.54±0.08、0.51±0.07、0.51±0.06、0.50±0.06(P<0.05);左室后壁厚度分别为(10.4±1.79)、(9.96±1.35)、(9.51±1.33)、(9.65±1.40)mm(P<0.05);室间隔厚度分别为(10.9±1.88)、(10.4±1.59)、(10.2±1.59)、(10.1±1.47)mm(P<0.05);此外四组间AIb、SBP、DBP均存在统计学差异(P<0.05). 结论:RRF每下降2 ml/min患者室间隔厚度、左室后壁厚度均增加,且室间隔厚度与RRF呈负相关.RRF对腹膜透析患者心血管并发症有重要影响.

Effects of residential renal function on cardiovascular system in patients with peritoneal dialysis

Objective: To reveal the relationship between residual renal function ( RRF) and cardiovascular complications in patients with peritoneal dialysis ( PD). Methodology: A total of two hundred and fourteen patients initiated PD between October 2002 and September 2008 was enrolled in this study. They had a mean of age 47. 4yrs ( range from 13 to 83), and a mean of follow lime 20. 2 months ( range from 4 to 77). 129 ( about 60. 3% ) patients' underlying disease was chronic glomerulonephritis, 33 (about 15.4% ) was diabetic nephropathy. 1 268 times follow-up in outpatient of the 214 patients were recorded. The records were divided into four groups according to RRF: Group A 0-2 ml/min; Group B 2-4 ml/min; Group C 4-6 ml/min; Group D >6 ml/min. The album, blood pressure, residual GFR (rGFR) , Urea Kt/V, creatinine clearance ( Gcr) , cardiothoraeic ratio and cardiovascular echogram were examined during the follow-up. ResuIts:The Kt/v total was 1.66 ±0.42, 1.85 ±0.40, 2. 11 ±0.45, 2.60 ±0.69 in Group A, B, C, D (P < 0.01). The cardiothoracic ratio was 0. 54 ±0. 08, 0. 51 ±0. 07, 0. 51 ±0. 06 and 0. 50 ±0. 06 respectively (P < 0. 05). The IVST ( interventricular septal thickness) was (10. 9 ±1. 88) , (10. 4 ±0.59) , (10. 2 ±0.59) and (10. 1 ±1. 47) mm respeeti vely(p< 0.05). The PWLV (posterior wall of left ventricle) was (10. 4 ±0.79), (9. 96 ±0.35), (9.51 ±0.33) and (9. 65 ±1. 40 ) mm ( P < 0. 05 ). The album and blood pressure also have statistical difference ( P < 0. 05 ). Conclusion: There is a close relationship between RRF and cardiovascular complications. IVST and PWLV increases when RRF declines every 2 ml/min, IVST correlated with RRF negatively.