尿素动力学模型在持续性非卧床腹膜透析中的应用

The clinical significance of urea kinetic modeling in patients on CAPD

对２０例ＥＳＲＤ患者先后给予持续性非卧床膜腹膜透析（ＣＡＰＤ）１Ｌ×５／ｄ和２Ｌ×４／ｄ方案透析，测定其尿素清除指数（ＫＴ／Ｖ）和标化每日蛋白质分解率（ＮＰＣＲ），同时应用１２个临床参数对两方案进行疗效评价．结果显示由ＩＬ×５／ｄ改为２Ｌ×４／ｄ时，ＫＴ／Ｖ和ＮＰＣＲ分别上升０．７４±０．２１和０．１２±０．０９（Ｐ＜０．００１），临床有效率上升８０％（Ｐ＜０．００５）；ＮＰＣＲ和ＫＴ／Ｖ呈正相关（ｒ＝０．４９，Ｐ＜０．０５）．ＮＰＣＲ与每日蛋白质摄入量（ＤＰＩ）呈高度正相关（ｒ＝０．９１，Ｐ＜０．００１），ＫＴ／Ｖ与临床评分也呈正相关（ｒ＝０．６１，Ｐ＜０．０１）．结果表明尿素动力学模型对评价ＣＡＰＤ治疗具有重要意义．

Twenty patients with end-stage renal disease were managed by CAPD IL×5/d and 2L×4/d regimens in turn. The urea clearance index(KT/V)and normalized protein catabolic rate(NPCR)were compared between the two regimens, and clinically assessed by 12 parameters.The results revealed that KT/V and NPCR increased 0.74±0.21 and 0.12±0.09 respectively(P<0.001), and the effective rate of the 2L×4/d regimen increased 80%(P<0.001)as compared with IL×5/d.Moreover, there was an inverse correlation between NPCR and KT/V(r=0. 49,P<0. 05),a high degree of positive correlation(r=0.91, P<0. 001)between NPCR and dietary protein intake, and KT/V was positively correlated with the clinical score(r=0. 61,P<0.01 ).It is claimed that urea kinetic modeling plays an important role in assessing the adequacy of treatment in patients on CAPD.