轻度肝脏损害对持续性非卧床腹膜透析患者血氨水平的影响

Effect of Mild Hepatic Function Impairment on Venous Ammonia in Continuous Ambulatory Peritoneal Dialysis Patients

目的:探讨持续性非卧床腹膜透析(CAPD)患者伴有轻度肝脏损害对血氨水平的影响。方法:对2010年3月在北京大学第三医院肾内科接受CAPD治疗的患者进行横断面调查。收集患者人口学资料,测定静脉血氨浓度,采用OH值评估容量状态,同时评估透析充分性、检测肝酶学及其他生化指标。所有患者根据肝酶水平分为两组,即轻度肝脏损害及肝功能正常组。采用均数比较、简单相关及多因素分析等方法探讨CAPD患者轻度肝功能损害与血氨水平之间的关系。结果:共139例符合条件的患者入选本研究。与肝功能正常患者相比,轻度肝功能损害患者血氨水平明显更高于[(43.95±8.47)μmol/Lvs(38.40±8.59)μmol/L,P<0.05],血清白蛋白[(36.23±5.17)g/Lvs(38.54±4.44)g/L,P<0.05]及血红蛋白水平[(105.71±17.39)g/Lvs(116.87±16.40)g/L,P<0.05]则更低。而血尿素、总的尿素清除率(tKt/V)及蛋白相当的总氮呈现率(PNA)在两组间差异无统计学意义。多因素分析显示轻度肝功能损害、低的残余肾尿素清除率及高的OH水平是影响腹膜透析患者血氨水平升高的独立危险因素(R2=0.249,P<0.05)。结论:轻度肝功能损害是导致腹膜透析患者血氨升高的重要原因,并且它与临床不良状况密切相关。

Objective：Objective To explore the effect of mild hepatic function impairment on venous ammonia in patients undergoing continuous ambulatory peritoneal dialysis（CAPD）.Methods：A cross sectional study was performed in CAPD patients from the division of nephrology,Peking University Third Hospital in March 2010.We collected data including demographic characteristics,volume status index expressed as OH（overhydration）,venous ammonia,dialysis adequacy,blood biochemistry and liver enzymes.According to the levels of liver enzymes,all patients were divided into two groups,that is,mild hepatic function impairment and normal hepatic function.Comparisons between groups,simple correlation and multivariate analysis were used to explore the relationship between the levels of venous ammonia and mild hepatic function impairment.Results：139 patients were included in the present study.Patients with mild hepatic function impairment had higher levels of venous ammonia[（43.95±8.47）μmol/L vs（38.40±8.59）μmol/L,P0.05] but lower levels of serum albumin [（36.23±5.17）g/L vs（38.54±4.44）g/L,P0.05] and hemoglobin [（105.71±17.39）g/L vs（116.87±16.40）g/L,P0.05] compared with those with normal hepatic function.There were no differences in plasma urea,total Kt/V and protein equivalent of nitrogen appearance（PNA）between two groups.Multivariate analysis showed that mild hepatic function impairment,renal Kt/V and overhydration were independent risk factors affecting the levels of venous ammonia（R2=0.249,P0.05）.Conclusion：Our study shows that mild hepatic function impairment may result in increased levels of venous ammonia,which is associated with adverse clinical outcomes in CAPD patients.