腹膜转运特性明显影响艾考糊精腹透液的超滤量

Great influence of peritoneal transport characteristics on ultraffitration of icodextrin

目的观察不同腹膜转运特性的患者使用7．5％艾考糊精腹透液长时间留腹后的超滤量。方法采用前瞻性、多中心、随机、双盲和平行对照临床研究的亚组分析。连续非卧床腹膜透析（CAPD）患者根据腹透液肌酐与血肌酐比值（D／Pcr）和Twardoski的评判标准，分为高转运、高平均转运、低平均转运和低转运4组。患者分别使用7．5％艾考糊精透析液或2．5％葡萄糖Dianeal PD-2、PD-4透析液，疗程4周。比较各组超滤量。结果共201例CAPD患者入选，其中艾考糊精组98例，葡萄糖组103例；男96例，女105例；年龄（56．1±13．7）岁（18-81岁）。198例进行了腹膜平衡试验，其中高转运患者24例（12．1％），高平均转运72例（36．2％），低平均转运81例（40．7％），低转运21例（11．0％）。治疗第4周，高转运、高平均转运和低平均转运患者中，艾考糊精组超滤量显著升高，无论与基线值还是与葡萄糖组比较，差异都有统计学意义；而低转运患者中，艾考糊精组超滤量高于葡萄糖组，但差异无统计学意义。相关分析显示，艾考糊精腹透液产生的超滤量与D／Pcr呈正相关（R^2=0．1681，P〈0．01），而葡萄糖透析液产生的超滤量与D／Pcr呈负相关（R^2=0．0949，P〈0．01）。结论7．5％艾考糊精腹透液可显著改善CAPD患者的超滤量和腹膜肌酐清除率，尤其在腹膜高转运、高平均转运和低平均转运患者，其作用显著优于葡萄糖腹透液。

Objective To observe the long dwell ultrafihration volume after using 7.5% icodextrin in different peritoneal transport characteristics of peritoneal dialysis patients. Methods Subgroup analysis of a perspective multicenter randomized double blind and parallel control study was performed. Continuous ambulatory peritoneal dialysis （CAPD） patients were divided into high transport （H） group, high-average transport （HA） group, low-average transport （LA） group and low transport （L） group according to D/Pcr and Twardoski standard. Ultrafiltration volume of night long dwell dialysate was calculated before and after clinic trial for 2 weeks and 4 weeks to evaluate the different effect of transporters on ultrafiltration volume. Results A total of 201 CAPD patients were enrolled in the study, including 98 patients in icodextrin group （ICO group） and 103 patients in glucose group （GLU group）. Male and female cases were 96 and 105 respectively. Age was （56.1±13.7） years old （range from 18 to 81）. One hundred and ninety-eight patients finished peritoneal equilibrium test （PET）, including 24 （12.1%） of H, 72（36.2%）of HA, 81（40.7%）of LA, and 21 （11.0%）of L. After follow-up for four weeks, the uhrafiltration volume was much higher than baseline in H, HA and LA groups. Also ultrafiltration volume in icodextrin group was much higher than that in glucose-based dialysate. Howerve, the increased volume was not significantly difference in L group. Ultrafiltration volume of icodextrin was positively correlated to D/Pcr （R^2= 0.1681,P〈0.01）, while ultratration volume of dextrose was negatively correlated to D/Pcr （R^2= 0.0949,P〈0.01 ）. Conclusion Compare to glucose-based dialysate （Dineal）, 7.5% icodextrin dialysate （Extraneal） improves the ultrafiltration and peritoneal creatinine clearance of long dwell notabily in H, HA and LA group.