透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Correlation of peritoneal albumin leakage with malnutrition-inflammation-atherosclerosis syndrome in continuous ambulatory peritoneal dialysis patients

目的探讨透出液蛋白丢失对连续性非卧床腹膜透析（CAPD）患者营养不良-炎性反应-动脉硬化（MIA）综合征的影响。方法对130例无明显水肿和活动性感染的CAPD患者进行横断面的研究。用标准腹膜平衡试验（PET）评估CAPD患者腹膜转运功能。颈动脉彩色超声检测颈动脉内膜中层厚度（IMT）。检测患者血清白蛋白、夜间留腹透出液蛋白和超敏C反应蛋白（hs-CRP）的水平。残余肾功能（rGFR）为24h尿尿素氮和尿肌酐清除的平均值。结果Pearson和Spearman相关分析显示，CAPD透出液蛋白的丢失与年龄、体质量指数（BMI）、夜间腹透液留腹的时间、血糖、4h透出液肌酐与血肌酐比值（4hD／Pcr）及hs-CRP水平呈正相关（分别为r=0．204，P〈0．05；r=0．314，P〈0．01；r=0．265，P〈0．01；r=0．212，P〈0．05；r=0．401，P〈0．01和r：0．216，P〈0．05）；与舒张压、血清白蛋白、透析液糖浓度及腹膜Kt／V呈负相关（分别为r=-0．209，P〈0．05；r=-0．123，P〈0．05；r=-0．271，P〈0．01；r=-0．212，P〈0．01）。总体上，透出液蛋白丢失量与IMT无相关，但患者rGFR小于1ml·min^-1·（1．73m2）^-1时，透出液蛋白丢失量与IMT呈正相关（r=0．650，P〈0．01）。结论CAPD患者透出液蛋白的丢失与患者腹膜转运类型、营养不良和炎性反应状态密切相关。患者rGFR小于1ml·min^-1·（1．73m2）^-1时，透出液蛋白的丢失是颈动脉动脉硬化的危险因素。

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atheroselerosis （MIA） syndrome in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test （PET） was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein （hs-CRP） levels were measured. Mean-carotid artery intima media thickness （IMT） was used to determine atherosclerosis. Residual glomerular filtration rate （rGFR） was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels （r=0.204, P〈0.05;r= 0.314, P〈0.01; r=0.265, P〈0.01; r=0.212, P〈0.05; r=0.401, P〈0.01; r=0.216, P〈0.05）; whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V （r=-0.209, P〈0.05; r=-0.123, P〈0.05; r=-0.271, P〈0.01; r=-0.212, P〈0.01）. Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients were further stratified into tertiles according to rGFR. IMT of those with rGFR 〈1 ml·min^-1·（ 1.73 m2 ）^-1 was signifieantly greater （P〈0.01）, and there was a positive correlation between peritoneal albumin leakage amount and IMT （r=0.650, P〈0.01）. Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients, High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min^-1 （1.73 m2）^-1.