小剂量日间非卧床腹膜透析对糖尿病肾病患者的临床疗效观察

Clinical efficacy of low-doses daytime ambulatory peritoneal dialysis in diabetic nephropathy patients

目的研究小剂量日间非卧床腹膜透析(DAPD)和小剂量持续非卧床腹膜透析(CAPD)对残肾功能较好的糖尿病肾病性尿毒症(DNU)患者的疗效。方法将38例DNU患者随机分为观察组和对照组,分别予DAPD模式、CAPD模式进行治疗,疗程为6个月。观察比较治疗前后两组的腹膜尿素氮清除率(Kt/V)、残肾Kt/V、残余肾小球滤过率(rGFR)、24 h尿蛋白量(Upro)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)及胰岛素(RI)使用剂量、24 h腹透液蛋白(Dpro)、血清白蛋白(ALB)、血红蛋白(HGB)的变化。结果治疗后,观察组的残肾Kt/V、rGFR、ALB、HGB显著高于对照组(P<0.05),Upro显著低于对照组(P<0.05),而观察组的腹膜Kt/V、FBG、HbA1c及RI使用剂量治疗前后均无显著变化(P>0.05),治疗后,对照组的FBG、HbA1c及RI使用剂量均显著高于观察组(P<0.01)。结论对于残肾功能较好的DNU患者,DAPD较CAPD能更好地保护患者的残肾功能,控制血糖,改善患者的营养状态。

Objective To study the efficacy of dose during non-ambulatory ambulatory peritoneal dialysis （DAPD） and low-dose continuous ambulatory peritoneal dialysis （CAPD） on diabetic nephropathy uremic syndrome （DNU） patients with better residual renal function. Methods 38 cases of DNU were randomly divided into observation group and control group, who were treated with the DAPD mode or CAPD mode respectively for 6 months. Observed and compared the peritoneal blood urea nitrogen clearance （Kt/V）, the remnant kidney of Kt/V, rGFR, 24 h urine protein （Upro）, fasting blood glucose （FBG）, glycated hemoglobin （HbA1c） and insulin （RI） dosage, 24 h dialysate protein （Dpro）, serum albumin （ALB）, hemoglobin （HGB） before and after treatment in both groups. Results After treatment, the residual renal Kt/V, rGFR, ALB, HGB of observation group was significantly higher （P 〈 0.05） and Upro was significantly lower than that of the control group （P 〈 0.05）, while peritoneal Kt/V, FBG, HbA1c, and RI dosage had no significant change before and after treatment （P 〉 0.05）, the FBG, HbAh, and RI dosage of control group were significantly higher than that of observation group （P 〈 0.01）. Conclusion For DNU patients with better residual renal function, DAPD may be better in protecting residual renal function, controlling blood sugar, improving the nutritional status of patients than CAPD patients with.