血液透析及腹膜透析对尿毒症患者血脂的影响及分析

The effects of hemodialysis and peritoneal dialysis on blood lipid in patients with uremia

目的观察尿毒症患者行血液透析或腹膜透析治疗前后的血脂水平的变化,对比血液透析及腹膜透析对尿毒症患者血脂影响的差别,并分析其可能的原因。方法纳入血液透析治疗组56例,腹膜透析组48例,所有患者均在透析治疗前及治疗12个月时测定血浆胆固醇(TCH)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、血浆白蛋白(ALB)、血肌酐(Scr)、血糖(Glu)等指标。结果经血液透析治疗的患者,TG较透析前明显升高(P<0.05),接受腹膜透析治疗的患者,TCH,TG,LDL,LDL/HDL较透析前均明显升高(P<0.05),腹膜透析与血液透析患者比较,前者TCH,LDL,LDL/HDL高于后者,ALB明显低于后者(P<0.05)。结论透析治疗加重脂代谢紊乱,腹膜透析患者脂代谢紊乱更明显,可能与含糖腹透液的使用及白蛋白大量丢失等因素相关。

Objective To survey the lipid levels before and after hemodialysis and peritoneal dialysis, explore the differ- ences of effects of hemodialysis and peritoneal dialysis on blood lipid in patients with uremia, and trace the possible causes. Meth- ods the hemodialysis group included 56 subjects, and the peritoneal group included 48 ones. The levels of plasma cholesterol （TCH）, triglyceride （TG）, low-density lipoprotein （LDL）, high-density lipoprotein （HDL）, albumin （ALB）, serum creatinine （ Scr）, glucose and so on were measured for all subjects. Those indices were measured before and after 12 months of dialysis. Re- stilts After the dialysis, the level of TG was elevated significantly in the hemodialysis group（P 〈 0. 05）. While in the peritoneal group, not only the level of TG but also TCH, LDL, LDL/HDL were elevated significantly after dialysis （ P 〈 0. 05 ）. Compared with the hemodialysis group, the level of TCH, LDL and LDL/HDL was higher in peritoneal group, while the level of ALB was signifi- cantly lower （P 〈 0. 05）. Conclusion Dialysis can aggravate the disturbance of lipid metabolism, especially the peritoneal dialy- sis, and it was possibly related to the use of glucose dialysate and the lose of albumin.