腹膜通透性对腹膜透析患者心脏结构的影响

The influence of peritoneal transport characteristic on the cardiac structure in patients who underwent peritoneal dialysis

目的探讨持续非卧床腹膜透析(CAPD)患者不同腹膜通透性对患者心脏结构的影响。方法选择透析12个月的CAPD患者52例,根据腹膜平衡实验(PET)结果将患者分为两组:高转运、高平均转运的患者为高通透性(H)组27例,低转运和低平均转运患者为低通透性(L)组25例。检测患者左心房内径(LAD)、左心室内径(LVD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及左心室射血分数(LVEF),并进行比较。结果与L组相比,H组患者血浆白蛋白[(33.46±3.08)g/L比(35.72±2.62)g/L,P=0.006)]明显降低,腹透液白蛋白丢失量[(6.41±1.15)g/24h比(5.51±1.18)g/24h,P=0.008]明显增多,室间隔厚度[(11.67±1.14)mm比(10.96±0.97)mm,P=0.020]、左室后壁厚度[(10.16±0.93)mm比(9.52±0.91)mm,P=0.016]明显增厚,左室射血分数[(59.37±3.31)%比(61.76±4.57)%,P=0.035]明显下降。单因素相关分析结果显示:腹透液白蛋白丢失量与血浆白蛋白及LVEF呈负相关关系(r=-0.503,P<0.01;r=-0.406,P=0.003);与IVST、LVPWT呈正相关关系(r=0.442,P=0.001;r=0.328,P=0.018)。结论高通透性CAPD患者较低通透性CAPD患者,左心室肥厚与左室射血功能的下降明显;腹透液白蛋白丢失量与CAPD患者的心脏改变有相关性。

Objective To explore the influence of different peritoneal transport on cadiac structure of perito-neal dialysis（PD）patients.Method A total of 52 patients with PD followed up more than 1 2 months were enrolled in this study.Patients were divided into two groups through peritoneal equilibration test（PET）：27 patients were high permeability（H）group included high-average and high transporters （H/A,D/P 〉0.65）,and 25 patients were low permeability（L）group included low-average and low transporters（L/A,D/P≤0.65）.Plasma albumin,creatinine, blood urea nitrogen and protein loss of dialysate were measured in all patients.Meanwhile LAD、LVD、IVST、LVPWT、LVEF were measured by ultrasonic Doppler before and after peritoneal dialysis.Results Compared with L group,the serum albumin[（33.46 ±3.08）g/L vs （35.72 ±2.62）g/L,P =0.006）]was decreased,plasma albumin loss from dialysis liquid[（6.41 ±1 .1 5）g/24h vs （5.51 ±1 .1 8）g/24h,P =0.008]was increased and IVST[（1 1 .67 ±1 .1 4） mm vs （1 0.96 ±0.97）mm,P =0.020],LVPWT[（1 0.1 6 ±0.93）mm vs （9.52 ±0.91 ）mm,P =0.01 6]was thic-ker in H group.Univariate correlation analysis showed that peritoneal albumin loss was negatively correlated to both plasma-albumin and LVEF（r =-0.503,P 〈0.001 ;r =-0.406,P =0.003）,and positively correlated to both IVST and LVPWT（r =0.442,P =0.001 ;r =0.328,P =0.01 8）.Conclusion High permeability PD patients have signifi-cantly changed in left ventricular structure and cardiac injection function.Peritoneal albumin loss is correlated with cardiac structure and function of PD patients.