腹膜溶质转运特性与蛋白质和氨基酸经透析液丢失

The relationship between peritoneal transport characteristics and the loss of protein and amino acids via dialysate during peritoneal dialysis

目的 探讨腹膜透析（ＰＤ）时腹膜溶质转运特性与蛋白质和氨基酸经ＰＤ液丢失的关系。方法 比较了２５ 名腹膜溶质转运特性为高转运或低转运的ＰＤ 患者每日经ＰＤ 液丢失总蛋白质、白蛋白和２１ 种氨基酸量的差别。结果 高转运组患者每日经透析液丢失的总蛋白、白蛋白和总氨基酸量均明显高于低转运组［分别为（６－９±２－４０） 比（４－９６±１－５０）ｇ／２４ｈ、（４－９±２－０） 比（３－２±１－４）ｇ／２４ ｈ 和（１５－２４±３－７０）比（９－８９±３－７０）ｍｍｏｌ／２４ ｈ，Ｐ值均＜０－０５］；高转运组患者血浆白蛋白水平明显低于低转运组（３４－９±１－０）比（３８－８±１－９）ｇ／Ｌ，两组有显著性差异（ Ｐ＜０－０５）。根据腹膜平衡试验确定的Ｄ／Ｐ４Ｃｒ 值与透析液中白蛋白和总氨基酸的丢失量呈显著正相关，与血浆白蛋白水平呈显著负相关。结论 高转运ＰＤ患者较低转运者丢失更大量的蛋白质和氨基酸，导致血浆白蛋白水平下降，营养不良。应高度重视慢性ＰＤ的高转运患者的营养管理问题。

Objective To explore the relationship between peritoneal transport characteristics and the loss of protein and amino acids via dialysate during peritoneal dialysis.Methods The differences of daily loss of total proteins,albumin,and 21 different amino acids via the dialysate in both high peritoneal transporter group and low transporter group were compared. Results The amounts of daily loss of total proteins, albumin and amino acids were significantly higher in high transporter group compared with that in low transporter group [(6 90±2 40)vs(4 96±1 50)g/24h,(4 9±2 0)vs(3 2±1 4)g/24h and(15 24±3 70)vs(9 89±3 70)mmol/24h respectively, all P values were less than 0 05].The serum albumin level in high transporter group was lower than that in low transporter group [(34 9±1 0)vs(38 8±1 9)g/L,P<0 05]. The amounts of the daily loss of albumin and total amino acids via dialysate were correlated significantly with D/P4Cr determined by the peritoneal equilibration test, and negatively correlated with serum albumin. Conclusions High transporters lose more proteins and amino acids compared with low transporters, which leads to a decrease of serum albumin and malnutrition. The nutrition status should be paid full attention in order to increase the quality of life and survival rate in high transporters undergoing chronic peritoneal dialysis.