替代治疗模式对尿毒症患者血脂代谢的影响

The modality of renal replacement therapy on serum lipid levels in uremic patients

目的比较高通量血液透析、常规血液透析与连续性非卧床腹膜透析3种不同的肾脏替代治疗模式对非糖尿病终末期肾病患者血脂代谢的影响。方法①将90例终末期肾病患者分为高通量血液透析组(HPD组)30例、常规血液透析组(CHD组)30例和连续性非卧床腹膜透析组(CAPD组)30例,分别进行维持性替代治疗并随访3年。入组后每3个月采血测定患者血浆胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A(Apo-A)、载脂蛋白B(Apo-B)。对比分析3组在透析开始时、透析1年后和透析3年后上述各项血脂指标的变化情况。②另选取血液透析与腹膜透析治疗模式相互转化的尿毒症患者各10余例,分别测定其在转变透析模式前和转变1年后上述各项血脂指标的变化情况。结果①透析开始时3组非糖尿病终末期肾病患者的血脂各项指标都基本一致,随着替代治疗时间的延长,HPD组内患者TC、TG、LDL和Apo-B逐渐降低,而HDL和Apo-A逐渐升高;CHD组和CAPD组的尿毒症患者随透析时间的延长,TC、TG、LDL和Apo-B都呈逐渐升高趋势,而HDL和Apo-A均逐渐降低,其中TG变化最明显(P<0.01);②常规血液透析转为腹膜透析1年后TC和TG的升高有显著性差异(均P<0.01)。而腹膜透析转为常规血液透析1年后除Apo-B由(0.81±0.61)升至(0.94.±0.35)g/L具有统计学差异(P<0.05)外,其余各项指标无变化。结论①常规血液透析和非卧床腹膜透析对尿毒症患者的血脂紊乱无改善,且有促进作用,尤其是腹膜透析影响更明显;②腹膜透析的尿毒症患者血脂表现的TC、TG增高比常规血液透析患者略明显,但只出现在透析治疗3年时;③高通量透析可以改善透析患者的血脂代谢。

Objective To compare the renal replacement modalities of high permeable hemodialysis（HPD）,conventional hemodialysis（CHD） and continuous ambulatory peritoneal dialysis（CAPD） on lipid metabolism in patients with end stage renal disease of non-diabetic causes.Methods Ninety patients with end stage renal disease were treated with maintenance renal replacement therapy of HPD（n=30）,CHD（n=30） or CAPD（n=30） for 3 years.Serum lipids were measured every 3 months.Of the 16 cases changed from hemodialysis to CAPD and the 14 cases changed from CAPD to hemodialysis,we observed their alterations in serum lipids before the change and after the new renal replacement therapy for 1 year.Results At the beginning of the treatment,no significant differences in serum lipids were found among the 3 groups.In patients treated with HPD,serum total cholesterol（TC）,triglycerides（TG）,low-density lipoprotein（LDL） and apolipoprotein B（Apo-B） decreased,and high-den-sity lipoprotein（HDL） and apolipoprotein A（Apo-A） increased gradually after the treatment.However,in those treated with CHD and CAPD,TC,TG,LDL and Apo-B increased,HDL and Apo-A decreased gradually after the treatment,and the increase of TG was most remarkable（P〈0.01）.In the 10 patients first treated with CHD and then changed to CAPD for one year,TC and TG increased significantly（P〈0.01）.In contrast,in those first treated with CAPD and then changed to CHD for one year,no significant alterations in serum lipids were found,except the increase of Apo-B from（0.81±0.61）g/L to（0.94.±0.35）g/L（P〈0.05）.Conclusion The derangement of lipid metabolism in uremic patients was aggravated by CHD and especially by CAPD,but was improved by HPD.After renal replacement therapy for 3 years,the increase of TC and TG was higher in patients treated with CAPD than in those treated with CHD.