腹膜转运和营养状况在腹膜透析充分性评价中的作用

Role of peritoneal transport characteristics and nutritional status in evaluation of peritoneal dialysis adequacy

目的探讨腹膜转运特性对尿毒症腹膜透析患者营养状态的影响，评价二者在腹膜透析充分性评价中的地位。方法采用快速腹膜平衡试验判断腹膜转运功能[腹膜透析液肌酐与血肌酐的比值（D／Per）]，将53例腹膜透析患者分为高转运（D／Per≥0．65）和低转运（D／Per〈0．65）两组。计算尿素清除指数（Kt／v）和总肌酐清除率（TCer）。采用实验室检查（血清白蛋白、前白蛋白和转铁蛋白，血红蛋白，瘦体重和瘦体重百分比）以及主观综合性评定法（SGA）评估患者的营养状况。结果低转运组包括患者30例，高转运组包括23例。高转运组患者的年龄、D／Per（0．82±0．15vs．0．55±0．08，P〈0．01）和TCer（62．93％±25．98％佛．49．69％±16．92％，P〈0．05）均显著高于低转运组，血清白蛋白和转铁蛋白，血红蛋白水平，瘦体重百分比和SGA评分均显著低于低转运组（P〈0．05），血清白蛋白与Kt／v呈显著负相关（r=-0．2708，P〈0．05）。结论腹膜高转运者溶质清除率高但营养状态较低转运者差。营养状况是判定透析是否充分的条件之一。应加强高转运及高龄患者的饮食管理和指导。

Objective To evaluate the influence of peritoneal transport characteristics on nutritional status of peritoneal dialysis patients and estimate the role of peritoneal transport characteristics and nutritional status in evaluation of peritoneal dialysis adequacy. Methods Peritoneal transport properties （D/Pcr） were evaluated by Short Peritoneal Equilibration Test and then 53 cases were divided into high transport group （ D/Pcr≥0. 65 ） and low transport group （ D/Per 〈 O. 65 ）. Urea kinetics （Kt/v） and total clearance of creatinine （TCcr） were calculated. Serum albumin （ALB）, prealbumin, transferring （TF）, hemoglobin （Hb）, lean body mass （LBM） and LBM% were examined or calculated. Subjective global assessment （SGA） was used to evaluate the nutritional status of patients. Results There were 30 cases in high transport group and 23 cases in low transport group. D/Per （0.82±0.15 w. 0.55±0.08, P〈0. 01）, TCcr （62.93% ±25.98% vs. 49.69% ±16.92%, P〈O. 05） and age were significantly higher in high transport group than those in low transport group, while ALB, TF, Hb, LBM%, and SGA were significantly lower than those in low transport group （ P 〈 0. 05 ）. ALB was negatively correlated with Kt/v （ r = - 0. 2708, P 〈 0. 05 ）. Conclusions High peritoneal transport patients have better solute clearance hut worse nourishment status compared with low transport ones. Nutritional status is one of the factors to evaluate dialysis adequacy. Nutrition management and guidance should be strengthened for the continuous ambulatory peritoneal dialysis patients, especially for the elderly ones.