二种不同葡萄糖浓度透析液对终末期糖尿病肾病血液透析患者血糖水平的影响

Two kinds of dialysate containing different glucose concentration on blood glucose in patients with endstage diabetic nephropathy undergoing hemodialysis

目的探讨终末期糖尿病肾病(end-stage diabetic nephropathy ESDN)血液透析患者透析液葡萄糖浓度的适合数值及临床意义。方法选择中山大学附属第五医院肾内科血液净化中心ESDN患者42名分为对照组、Ⅰ组、Ⅱ组,血液透析(hemodialysis HD)时分别使用无糖透析液和葡萄糖浓度为4.5mmol/L、6.0mmol/L的含糖透析液,并检测患者每次透析1、2、3h的血糖浓度;之后所有患者改用葡萄糖浓度为6.0mmol/L的透析液透析,测定单次透析前后血清果糖胺(serum fructosamine FA)水平及透析2h血糖水平。透析前血清FA高于2.2mmol/L的患者为A组,血析前血清低于2.2mmol/L的为B组。结果①416次透析中对照组及Ⅰ组患者各时段低血糖的发生率均高于Ⅱ组并且差异有显著性(P<0.05);而对照组与Ⅰ组患者各时段低血糖的发生率比较差异没有显著性;②透析2h及3h各组低血糖的发生率均高于1h,差异亦有显著性(P<0.01);而各组透析2h与3h时低血糖的发生率比较差异没有显著性;③A、B两组透析2h时B组低血糖的发生率高于A组,差异具有显著性(P<0.01)。④透析前后血清FA的变化差异没有显著性。结论①使用无糖透析液及透析液葡萄糖浓度为4.5mmol/L的患者低血糖的发生率高于使用透析液葡萄糖浓度为6.0mmol/L的患者差异有显著性;②透析前血清FA低于正常的患者血液透析中容易发生低血糖;③血液透析不能清除血清FA。

Objective To investigate the suitable dialysate glucose concentration and its clinical significance in hemodialysis patients with end-stage diabetic nephropathy. Methods Forty-two patients with end-stage diabetic nephropathy were randomly divided into three groups, to which dialysate containing glucose 0 mmol/L （control group）, 4.5 mmol/L （group Ⅰ） and 6.0 mmol/L （group Ⅱ）, respectively, was used during hemodialysis. Blood glucose was determined every hour for 3 hours after the beginning of the hemodialysis. Subsequently, dialysate containing 6.0 mmol/L glucose was used to all patients, serum fructosamine （FA） was measured before and after the dialysis, and blood glucose was determined 2 hours after the dialysis. Patients were then divided into two groups： group A, FA 〉2.2 mmol/L and group B, FA 〈 2.2 mmol/L. Results （a） In the 416 hemodialyses, the rate of hypoglycemia within the 3 hours was higher in control group and group Ⅰ than in group Ⅱ （P 40.05）, but had no difference between control group and group Ⅰ. （b） In the 3 groups, the rate of hypoglycemia was higher after the dialysis for 2-3 hours as compared with that after one hour （P 〈 0.01）, but had no difference after the dialysis for 2-3 hours. （c） With regard to group A and B, the rate of hypoglycemia was higher in group B after the dialysis for 2 hours （P 〈 0.01）. （d） No change of FA was found in these patients before and after the dialysis. Conclusions （a） The rate of hypoglycemia was higher in patients using dialysates containing 0-4.5 mmol/L glucose than in those using dialysate of 6 mmol/L glucose. （b） Hypoglycemia during hemodialysis is frequently seen in patients with lower FA. （c） FA can not be cleaned up by hemodialysis.