多环芳烃成分菲与腹膜透析患者临床指标的相关性

Correlation between polycyclic aromatic hydrocarbons component phenanthrene and clinical indicators in patients on peritoneal dialysis

目的探讨多环芳烃(PAHs)成分菲(PHE)与持续非卧床腹膜透析(CAPD)患者临床指标的相关性。方法病例对照研究。纳入2018年6至8月于郑州大学第一附属医院行腹膜透析置管并规律透析的22例患者作为CAPD组,同期选择本院健康体检者18名作为对照组。留取空腹血标本检测PAHs各组分浓度,进行差异比较,并进一步分析PAHs成分与临床指标的相关性。结果CAPD组患者22例,男13例,女9例,年龄(45±13)岁;对照组18名,男6名,女12名,年龄(41±13)岁。血PHE浓度在CAPD患者中最高,为0.449(0.254,0.581)mg/L,在对照组中浓度仅次于苊,为0.081(0.050,0.444)mg/L,两组之间血PHE浓度差异有统计学意义(P=0.008)。CAPD患者血PHE浓度与每周尿素清除指数(Kt/V)、每周肌酐清除率(Ccr)、白细胞计数均呈负相关,与甘油三酯水平呈正相关(r值分别为-0.743、-0.749、-0.655、0.610,均P<0.05)。简单线性回归分析结果显示,PHE浓度每增加0.1 mg/L,每周Kt/V下降0.226,每周Ccr下降3.050 L/1.73 m^(2),白细胞计数下降0.512×10^(9)/L,甘油三酯水平升高0.152 mmol/L(均P<0.05)。多重线性回归分析结果显示,CAPD患者血PHE浓度与每周Kt/V、每周Ccr水平负相关(t值分别为-2.402、-2.368,均P<0.05)。对22例CAPD患者进行为期3年的随访,期间有8例(36.4%)患者因技术失败退出腹膜透析,基线血PHE浓度高于未退出腹膜透析的患者[0.572(0.416,0.662)比0.268(0.120,0.475)mg/L,P=0.003]。8例患者(36.4%)发生了心血管事件,基线血PHE浓度高于未发生心血管事件的患者[0.542(0.389,0.741)比0.373(0.157,0.545)mg/L,P=0.045]。结论PHE与CAPD患者临床指标Kt/v、Ccr、白细胞、甘油三酯具有相关性。

Objective To explore the correlation between polycyclic aromatic hydrocarbons(PAHs)component phenanthrene and clinical indicators in patients on continuous ambulatory peritoneal dialysis(CAPD).Methods A total of 22 patients who underwent peritoneal dialysis catheterization and regular dialysis in the First Affiliated Hospital of Zhengzhou University from June to August 2018 were selected.Meanwhile,18 healthy adults who underwent physical examination were also selected as the control group.Fasting blood samples were taken to detect the concentration of PAHs components for comparison,and the correlation between PAHs components and clinical indicators was further analyzed.Results There were 22 cases in CAPD group(13 males and 9 females),and aged(45±13)years,while there were 18 cases in control group(6 males and 12 females),and aged(41±13)years.The concentration of blood phenanthrene(PHE)was the highest in CAPD group[0.449(0.254,0.581)mg/L],and it was only lower than acenaphthene in the control group[0.081(0.050,0.444)mg/L],with a statistically significant difference between the two groups(P=0.008).The analysis of PHE and clinical indicators showed that the concentration of PHE in CAPD patients was negatively correlated with weekly urea clearance index(Kt/V),weekly creatinine clearance(Ccr)and leukocyte level,but positively correlated with triglyceride level(r=-0.743,-0.749,-0.655 and 0.610,respectively,all P<0.05).Simple linear regression analysis demonstrated that for every 0.1 mg/L increase in PHE concentration,weekly Kt/V,weekly Ccr and white blood cell count decreased by 0.226,3.050 L/1.73 m^(2) and 0.512×10^(9)/L,respectively,but triglyceride level increased by 0.152 mmol/L(all P<0.05).Multiple linear regression analysis revealed that the blood PHE concentration of CAPD patients was negatively correlated with weekly Kt/V and Ccr levels(t=-2.402 and-2.368,respectively,both P<0.05).All CAPD patients were followed up for 3 years,during which 8 patients(36.4%)withdrew from peritoneal dialysis due to technical failure,and the baseline PHE concentration was higher than that of patients who did not quit peritoneal dialysis[0.572(0.416,0.662)vs 0.268(0.120,0.475)mg/L,P=0.003].Eight patients(36.4%)had cardiovascular events,and the baseline blood PHE concentration was higher than that of patients without cardiovascular events[0.542(0.389,0.741)vs 0.373(0.157,0.545)mg/L,P=0.045].Conclusion PHE correlates with clinical indicators of CAPD patients,including Kt/v,Ccr,leukocyte and triglyceride.