腹膜透析患者腹膜功能与微炎症因子的关系

Correlation of micro-inflammatory status with peritoneal function in peritoneal dialysis patients

目的探讨腹膜透析患者血清、透出液中的IL-6、CRP与腹膜转运功能之间的关系。方法选取规律随访且没有明显炎症的维持性腹膜透析患者44例,入选患者在腹膜透析1个月时行腹膜平衡试验(PET)。根据透出液/血浆肌酐浓度比值(D/Pcr)将患者分为UA组(D/Pcr≤0.64)22例和H/A组(D/Pcr≥0.65)22例,腹膜透析6个月时再次行PET检查。检测腹膜透析后1、6个月的血清及透出液中CRP、IL-6水平,分析其与腹膜转运功能的关系。结果两组患者在年龄、残余肾功能和尿素清除指数(KT/N)间差异无统计学意义,H/A组血清白蛋白水平低于L/A组,H/A组患者夜间超滤量明显少于L/A组。UA组和H/A组腹膜透析6个月后血清CRP水平均高于1个月;H/A组腹膜透析1、6个月血清CRP水平高于L/A组,腹膜透析6个月透出液CRP水平高于L/A组。L/A组和H/A组在腹膜透析6个月血清IL-6水平均明显高于1个月;H/A组腹膜透析1、6个月血清IL-6水平均高于L/A组。L/A组6个月后透出液IL-6水平明显高于1个月;H/A组腹膜透析1个月时透出液IL-6水平明显高于L/A组。患者腹膜转运功能可能与血清CRP和IL-6相关,血清CRP和IL-6是影响腹膜转运功能的危险因素。结论患者腹膜转运功能可能与血清CRP和IL-6相关,全身微炎症是影响腹膜转运功能的危险因素。

Objective To investigate the relationship between micro-inflammatory status and peritoneal transport function. Methods Forty four patients without apparent inflammation undergoing continuous ambulatory peritoneal dialysis （CAPD） in Dialysis Center of our hospital were enrolled in the study. Peritoneal equilibration test （PET） was performed in patients after one month of dialysis, according to D/Pcr value, the patients were divided into L/A group （D/Pcr ≤0.64, n=22） and H/A groups （D/Per ≥0.65, n=22）. PET was performed again after 6 months of dialysis, the serum and dialysate levels of CRP, IL-6 were measured. The correlation of the serum and dialysate levels of CRP, IL-6 with peritoneal transport function was analyzed. Results There was no significant difference in age, residual renal function, the fasting blood glucose and total Kt/V between two groups. The serum albumin level, peritoneal dialysis ultrafiltration volume at night in H/A group was significantly lower than those in L/A group. Serum CRP level in both H/A and L/A groups were higher at 6 months than that at 1 month; however, the level in H/A group was higher than that in L/A group both at 6 months and 1 month of dialysis. Dialysate CRP level in H/A group was higher than that in L/A group at 6 months of dialysis. Serum IL-6 levels in both H/A and L/A groups were higher at 6 months than those at 1 month; however, the level in H/A group was higher than that in L/A group both at 6 months and 1 month of dialysis. The IL-6 level in dialysate of H/A group was higher than that of LJA group at 1 month of dialysis; the level of L/A group at 6 months was higher than that at 1 month. Serum CRP level was positively correlated with IL-6 level. Wald regression analysis showed that peritoneal transport function in patients was correlated with serum levels of CRP and IL-6. Conclusion Peritoneal transport function is correlated with circulating markers CRP and IL-6, micro-inflammation may be a risk factor of decreased peritoneal transport function in patients undergoing CAPD.