维持性腹膜透析患者腹膜转运类型与血清C反应蛋白的关系

Relationship between peritoneal transport type and serum C-reactive protein in maintenance peritoneal dialysis patients

目的分析维持性腹膜透析（MPD）患者的腹膜转运类型与血清C反应蛋白（CRP）的关系。方法将行MPD且规律（每3个月）随访的56例患者（MPD组）行标准腹膜平衡试验（PET），根据其D／P值分为高通透性组（D／P〉0．65，18例）和低通透性组（D/P≤0．65，38例）。于PET当天行血清肌酐、尿素氮、尿酸、CRP等及透析液肌酐、尿素氮、尿酸等的检测，计算患者尿素清除指数和内生肌酐清除率。根据PET结果制定透析处方，使尿素清除指数≥1．7，内生肌酐清除率≥50L/（周·1．73m^2）。MPD6个月后再次检测上述指标。并与尿毒症非透析患者30例（尿毒症非透析组）和健康体检者20例（对照组）进行比较。结果高通透性组、低通透性组、尿毒症非透析组血清CRP均高于对照组[（54．41±17．77）、（43．34±18．07）、（39．10±17．86）mg／L比（2．00±0．36）mg／L，P〈0．05]，高通透性组血清CRP高于低通透性组（P〈0．05）。MPD组与尿毒症非透析组血清CRP比较差异无统计学意义（P〉0．05）。高通透性组和低通透性组MPD6个月后血清CRP与PET当天比较差异无统计学意义（P〉0．05）。且MPD6个月后，有6例低通透性患者转为高通透性，该6例患者置管1个月后的血清CRP明显高于其他32例腹膜转运类型仍为低通透性患者[（64．45±13．05）mg／L比（39．38±16．12）mg／L，P〈0．05]。结论尿毒症患者体内存在微炎性反应状态。MPD患者腹膜转运特性以低通透性为主。腹膜转运特性为高通透性患者体内存在的微炎性反应状态严重于低通透性患者。MPD不能改变尿毒症患者的CRP水平。尿毒症患者的原始微炎性反应状态或许影响了其腹膜转运功能。

Objective To evaluate the relationship between peritoneal transport type and serum C-reactive protein （CRP） in maintenance peritoneal dialysis （MPD） patients. Methods Standard peritoneal equilibration test （PET） was perfomled in 56 MPD patients （MPD group） with regular follow-up. According to D/P values,56 patients were divided into high permeability group （D/P 〉 0.65, 18 cases） and low permeability group （D/P ≤ 0.65,38 cases ）. In parallel at the date of PET examination, serum ereatinine, blood urea nitrogen, uric acid, CRP and dialysate creatinine, blood urea nitrogen, uric acid was tested with an automatic biochemical analyzer, and urea clearance index and creatinine clearance rate was calculated. Dialysis prescription was formulated accordingto PET results to reach the criteria urea clearance index ≥ 1.7 and creatinine clearance rate ≥ 50 L/（week 1.73 m^2）. Six months after MPD treatment, these indexes were detected again. And 20 cases of healthy person （control group） and 30 cases of uremic non-dialysis patients （uremic non-dialysis group） were selected randomly. Results The serum CRP level in high permeability group, low permeability group, uremic non-dialysis group was higher than that in control group [（54.41 ± 17.77）, （43.34 ± 18.07）, （39.10 ± 17.86） mg/L vs. （2.00 ± 0.36） mg/L,P 〈 0.05 ]. The serum CRP level in high permeability group was higher than that in low permeability group （P 〈 0.05 ）. There was no significant difference in the serum CRP level between MPD group and uremic non-dialysis group （P 〉 0.05 ）. There was no significant difference in the serum CRP level between 6 months after MPD and the date of the PET examination in high permeability group, low permeability group （P 〉 0.05 ）. Six patients with low permeability peritoneal transport changed into the high permeability at 6 months after MPD. The serum CRP level in these 6 patients at 1 month after catheter were significantly higher than the other patients of the low permeability [（64.45 ± 13.05） mg/L vs. （39.38 ± 16.12） mg/L,P〈0.05]. Conclusions Uremic patients in vivo exist micro-inflammatory state. The peritoneal transport characteristics of MPD patients are mainly in low permeability. Peritoneal transport characteristics of high permeability in vivo in patients with existing micro-inflammatory status are more severe than those in patients with low permeability. MPD treatment can not change the serum CRP levels in uremic patients. The original micro-inflammatory state in uremic patients may affect their peritoneal transport type.