腹膜透析联合血液透析对终末期肾脏疾病患者心血管病变的改善作用

Effect of peritoneal dialysis combined with hemodialysis on cardiovascular disease in patients with end stage renal disease

目的通过对腹膜透析联合血液透析(peritoneal dialysis combined with hemodialysis,PHD)后与联合治疗前相关指标进行比较,探讨联合治疗对终末期肾脏疾病(end stage renal disease,ESRD)患者心血管病变的改善作用。方法回顾性分析济宁医学院附属医院肾内科14例腹膜透析(peritoneal dialysis,PD)治疗不充分的ESRD患者,改用PHD治疗后的临床疗效。随访观察患者的一般状况、临床表现、营养状态,收集其治疗前后生化指标、甲状旁腺素、β_2微球蛋白(β_2-microglobulin,β_2-MG)、颈动脉内中膜厚度(carotid intima media thickness,CIMT)、收缩压、舒张压、左室射血分数、B型钠尿肽(B type natriuretic peptide,BNP)进行分析。结果经过PHD治疗后患者饮食好转,恶心、呕吐等消化道症状消失,曾反复心力衰竭的3例患者行PHD治疗后未再出现,皮肤瘙痒及不宁腿症状明显减轻。PHD前与PHD治疗后比较,血磷:(1.76±0.41)mmol/L与(1.48±0.28)mmol/L,P>0.05;甲状旁腺素:(367.93±166.66)ng/L与(237.07±76.21)ng/L,P<0.05;BNP:(1 521.7±701.0)μg/L与(712.1±535.0)μg/L,P<0.01;左室射血分数:(49.7±3.1)%与(52.2±1.8)%,P<0.05;颈动脉内中膜厚度:(1.65±0.36)mm与(1.72±0.33)mm,P>0.05,PHD治疗后较PHD前无明显改变。结论 PHD能减轻患者的临床症状,改善患者的营养状态,降低血磷,减轻继发性甲状旁腺功能亢进,延缓动脉硬化进展,可作为一种新的肾脏替代治疗模式在临床推广。

Objective To investigate the effect of peritoneal dialysis combined with hemodialysis （PHD） on the improvement of cardiovascular disease in patients with end-stage renal disease （ESRD）. Methods In this retrospective analysis, the clinical characteristics and outcomes of 14 patients with end-stage renal disease who comes from the department of internal medicine, Affiliated Hospital of Jining Medical College in Shandong and had switched from PD alone to combined therapy with PHD were studied. The general status, clinical manifestations and nutritional status of the patients were followed up, and the biochemical indicator, parathyroid hormone, Carotid intima media thickness （CIMT）, β2-microglobulin（β2-MG）, systolic and diastolic blood pressure, left ventricular ejection fraction and B type natriuretic peptide（BNP ）before and after treatment were analyzed. Results After the treatment of PHD , diet improve, nausea, vomiting and other gastrointestinal symptoms disappear, 3 patients who have repeatedly heart failure don＇t occur heart failure after the treatment of PHD, pruritus and restless legs symptoms significantly reduced, serum phosphorus [（1.76 ± 0. 41 ） mmol/L vs. （1.48 ± 0. 28） mmol/L, P〉0. 05] parathyroid hormone [（367. 93 ± 166. 66） ng/L vs. （237. 07±76. 21） ng/L,P〈0. 05], BNP [（1 521.7 ± 701.0） μg/L vs. （712. 1 ± 535. 0） μg/L, P〈0. 01]were significantly decreased, the left ventricular ejection fraction was increased [（49. 7 ± 3.1） % vs. （52. 2 ± 1.8）%,P〈0. 05], the CIMT [（1.65 ± 0. 36） mm vs. 1.72 ± 0. 33） mm, P〉0. 05]had no obvious changes compared with pre-treatment. Conclusions PHD can relieve the clinical symptoms, improve the nutritional status of patients, reduce serum phosphorus and hyperparathyroidism, delay the progress of atherosclerosis, and it can as a new renal replacement treatment uses in clinical.