血液透析和腹膜透析用于终末期肾病伴晚期肝硬化患者的效果比较

Effect comparison of hematodialysis and peritoneal dialysis used for endstage renal disease combined with advanced liver cirrhosis

目的比较血液透析和腹膜透析用于终末期肾病伴晚期肝硬化患者的效果。方法选择2013年8月～2015年8月青岛市中心医院肾内科收治的终末期肾病伴晚期肝硬化患者94例作为研究对象，将所有患者按随机数字表法分为血液透析组和腹膜透析组。每组各47例。观察两组患者透析前和透析6个月后平均动脉压（MAP）、三酰甘油（TG）、总胆固醇（TC）、尿素氮（BUN）、肌酐（SCr）、肾小球滤过率（GFR）、β2微球蛋白、血氨、血红蛋白（Hb）、血清白蛋白（ALB）水平。采用肾脏疾病生活质量简表（KDQOL—SFTM）评价患者生存质量，并记录两组透析6个月后并发症发生情况。结果两组透析6个月后MAP、血氨水平均较透析前显著降低，Hb水平较透析前显著升高（P〈0．05），但两组透析后上述指标比较差异无统计学意义（P〉0．05）。两组透析6个月后TC、BUN、SCr、GFR、β2微球蛋白均较透析前显著下降（P〈0．05），且腹膜透析组TC、β2微球蛋白显著低于血液透析组，BUN、SCr、GFR显著高于血液透析组（P〈O．05）。透析6个月后，腹膜透析组社会功能、肾病对日常生活的影响、工作状况、社交质量评分均显著高于血液透析组（P〈0．05）。透析6个月后，腹膜透析组消化道出血、皮下出血、抽搐、频发低血压发生率均明显低于血液透析组（P〈0．05）。结论与血液透析相比，腹膜透析治疗终末期肾病伴晚期肝硬化患者效果好．患者生存质量高．且并发症少，值得临床推广应用。

Objective To compare the effect of hematodialysis and peritoneal dialysis used for end-stage renal disease combined with advanced liver cirrhosis. Methods Ninety-four cases of patients with end-stage renal disease combined with advanced liver cirrhosis admitted to Department of Nephrology, Qingdao Central Hospital from August 2013 to August 2015 were selected as research objects, and they were randomly divided into the hematodialysi group and the peritoneal dialysis group by random number table, with 47 cases in each group. The mean arterial pressure （MAP）, triacylglyeerol （TG）, total cholesterol （TC）, blood urea nitrogen （BUN）, creatinine （SCr）, glomerular filtration rate （GFR）, 132-microglobulin, blood ammonia, hemoglobin （Hb）, serum albumin （ALB） of the two groups before hemodi＇alysis and after hemodialysis for 6 months were observed..The kidney disease quality of life - short form （KDQOL-SFTM） was used to evaluate the quality of life, and the complications of the two groups after hemodialysis for 6 months were recorded. Results The levels of MAP, blood ammonia of the two groups after hemodialysis for 6 months were all decreased compared with those before hemodialysis, Hb was increased significantly compared with before hemodialysis （P 〈 0.05）, but there were no statistically significant differences of the indexes above between the two groups （P 〉 0.05）. The levels of TC, BUN, SCr, GFR, 132-microglobulin of the two groups after hemodialysis for 6 months were all significantly decreased compared with those before hemodialysis （P 〈 0.05）, and the levels of TC, 132-microglobulin in peritoneal dialysis group were significantly lower than those of the hemodialysis group, the levels of BUN, SCr, GFR were significantly higher than those of the hemodialysis group （P 〈 0.05）. After hemodialysis for 6 months, the scores of social function, effect of kidney disease for daily life, working conditions, quality of social interaction in peritoneal dialysis group were all significantly higher than those of hemodialysis group （P 〈 0.05）. After hemodialysis for 6 months, the incidence of alimentary tract hemorrhage, subcutaneous hemorrhage, convulsion, frequent hypotension in peritoneal dialysis group were significantly lower than those of hemodialysis group （P 〈 0.05）. Conclusion Compared with hemato- dialysis, peritoneal dialysis in the treatment of end-stage renal disease combined with advanced liver cirrhosis has better effects, the quality of life is higher, the complication is less, which is worthy of clinical promotion and application.