慢性腹透患者透析充分性和营养状况的临床评估

Clinical evaluation of dialysis adequacy and nutritional state in chronic peritoneal dialysis patients

本文对53例慢性腹透（PD）患者通过测定整体尿素清除率（KT／V）、肌酐清除率（Ccr）、蛋白分解代谢率（PCR）、标准蛋白分解代谢率（nPCR）、白蛋白（ALB）、臂肌面积（AMA）来观察腹透的充分性和有关营养状况．结果表明：①KT／V与Ccr有显著相关性（r=067，P＜0．01），其中KT／V＜1．4的16例，Ccr＜50／周14例（占28.3％）；②KT／V、Ccr与PCR、nPCR有显著相关性（r=0．36～0．72，P＜0．01），W、Ts、AMA与PCR有显著相关性（r=0．29～0．27，P＜0．05）；③高龄者、近期透析者ALB偏低．提示KT／V、Ccr是了解透析充分性、调节透析量的有效手段．PCR、nPCR在评估PD患者营养状态中，肥胖及消瘦者可影响nPCR的结果．

Background With the development of dial-ysis technic and dialystae quality,people pay more attention to dialysis quality. There were 53 peritoneal dialysis patients in our study. We made dialysis prescription accord-ing to PET. We determined their KT/V,Ccr, PCR, nPCR, ALB, AMA in order to e-valuate dialysis adequacy and nutritional state to improve dialysis quality.ExPerimental design We collected PD pa-tients 24 hour dialysate and urine, at the same time measured serum Cr, BUN. Ac-cording to KHANNA/JOHNC formulae,we obtained KT/V, Ccr, PCR, nPCR, DPI. We calculated bone-free AMA according to the methods and formulae provided by FRI-SANCHO.Results ①KT/V was significantly corre-lated to Ccr (r= 0. 67,P＜0. 01 ),sixteen of them KT/V＜1. 4, fourteen of them Ccr＜50L/w (23. 8% )'② There was significant correlation among KT/V, Ccr and PCR,nPCR (r=O- 36~0. 72,P＜0. 01),the same result was found among W, Ts, AMA and PCR (r= - 0. 29~0. 27,P＜0. 05). ③ALB was low in elder and newly dialysis pa-tients. ④ KT/V was relatively higher in high transfer patients.Concluslons ① We can evaluate dialysis adequacy, regulate dialysis dose by KT/V,Ccr. ② Residual renal function and peri-toneal function played an important role in this course. ③PCR and nPCR can be affect-ed by dialysis adequacy, and PCR may be more valuable in evaluating the nutritional state of PD patients.