不同透析方式治疗终末期糖尿病肾病临床疗效比较

Clinical Curative Comparison between Two Ways of Dialysis Treatment of Patient with end-stage Diabetic Nephropathy

目的:比较应用血液透析(hemodialysis,HD)与持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)两种不同透析方式治疗终末期糖尿病肾病的临床疗效。方法:回顾性分析2010年6月至2013年2月在我院接受透析治疗的终末期糖尿病肾病患者98例的临床资料,其中55例为接受HD治疗,43例接受CAPD治疗,统计分析及比较两组的临床治疗效果。结果:HD组透析后的体重(50.2±8.9Kg)较透析前(58.4±10.1Kg)明显减轻(P<0.05),也明显低于CAPD组透析后体重(60.4±9.1 kg)(P<0.05),HD组透析后血压下降明显(SBP 157.6±20.2 vs 144.3±14.4 mmHg,DBP 71.4±12.9 vs 83.2±10.9 mmHg)(P<0.05),同时明显低于CAPD组透析后血压(SBP 144.3±14.4 mmHg vs 159.4±17.1 mmHg,DBP 71.4±12.9 vs 84.3±10.5 mmHg)(P<0.05),两组透析后尿量与透析前比较无明显差异(>0.05),但HD组尿量(487.0±332.0mL)明显少于CAPD组(593.0±420.0 ml)(P<0.05),两组透析后生化指标如肌酐(HD 310.6±210.1μmol/L,CAPD425.9±267.2μmol/L)、尿素氮(HD 11.6±4.1 mmol/L,CAPD 19.5±6.9 mmol/L)、血钾(HD 3.4±0.4 mmol/L,CAPD 3.6±0.5 mmol/L)有明显下降(P<0.05),HD组透析后血浆总蛋白(59.4±8.1 g/L)及白蛋白(37.4±6.1 g/L)水平较透析前(TP 55.2±9.0 g/L,ALB 33.2±5.9 g/L)显著性升高(P<0.05),且HD组血浆总蛋白(55.2±9.0g/L)及白蛋白水平(33.2±5.9 g/L)显著高于CAPD组(TP 52.5±7.3 g/L,ALB 33.4±5.1 g/L)(P<0.05),HD组发生心血管并发症(36.3%)、出血事件(30.9%)的比例较CAPD组(16.2%,13.9%)升高,差异具有统计学意义(P<0.05)。结论:两种透析方式都是治疗终末期糖尿病肾病的有效措施,两者各有特点。对于不同病人应采取个体化方针,能够提高患者的生活质量,减少并发症及改善预后。

Objective： To discuss and compare the clinical curative effect of application of hemodialysis（HD） and continuous ambulatory peritoneal dialysis（CAPD） on patients with terminal-stage diabetic nephropathy. Methods： A retrospective review was conducted on the data of 98 patients with terminal-stage diabetic nephropathy who underwent dialysis therapy in our hospital between June 2010 and February 2013. Among them, 55 had HD treatment and the other 43 received CAPD. The clinical therapeutic effect of the two therapies were analyzed and compared between the two groups. Results： The patients in HD group had their weights（50.2±8.9 Kg）down significantly after dialysis（58.4±10.1 Kg）（P〈0.05） and had less weight after dialysis than that in the CAPD group（60.4±9.1 kg）（P〈0.05）. The blood pressure of the patients in HD group greatly declined after dialysis（SBP 157.6±20.2 mmHg vs 144.3±14.4 mmHg,DBP 71.4±12.9 mmHg vs 83.2±10.9 mmHg）（P〈0.05） and was lower than that of patients in CAPD group after dialysis（SBP 144.3±14.4 mmHg vs 159.4±17.1 mmHg, DBP 71.4±12.9 mmHg vs 84.3±10.5 mmHg）（P〈0.05）. The urine volume of the two groups after dialysis were similar with that before dialysis, but patients in HD group had less urine volume（487.0±332.0 ml） than those in CAPD group（593.0±420.0 ml） after dialysis（P〈0.05）. The biochemical indicators such as creatinine（HD 310.6 ±210.1 μmol/L, CAPD425.9±267.2 μmol/L）, urea nitrogen（HD 11.6±4.1 mmol/L, CAPD 19.5±6.9 mmol/L）, potassium（HD 3.4±0.4mmol/L, CAPD 3.6±0.5 mmol/L） after dialysis were significantly lower than those before dialysis（P〈0.05）. The level of plasma total protein（59.4±8.1 g/L）and plasma albumin（37.4±6.1 g/L） of patients in HD group after dialysis were significantly higher than those before dialysis（TP 55.2±9.0 g/L, ALB 33.2±5.9 g/L）（P〈0.05）, and the two levels after dialysis in HD group（TP 55.2±9.0 g/L, ALB 33.2±5.9g/L） were also significantly higher than that in CAPD group（TP 52.5 ±7.3g/L, ALB 33.4 ±5.1 g/L）（P〈0.05）. The incidences of cardiovascular complications（36.3%） and bleeding（30.9%） in HD patients were higher than in CAPD patients（16.2% and 13.9%, respectively）（P〈0.05）. Conclusions： Both dialysis methods were effective measures to treat patients with terminal-stage diabetic nephropathy and had their own characteristics. We can improve the quality of life of patients, reduce incidence of complications and promote prognosis by means of individualized principle for different patients.