糖尿病肾病腹膜透析患者残余肾功能下降的危险因素分析

Risk factors analysis for peritoneal dialysis patients with diabetic nephropathy with residual renal function declining

目的分析影响糖尿病肾病腹膜透析患者残余肾功能(residual renal function,RRF)下降的危险因素。方法选取2007—2014年浙江大学附属第一医院肾脏病中心规律持续性不卧床腹膜透析(CAPD)患者880例,其中原发病为糖尿病肾病的患者150例,非糖尿病肾病患者730例。测定其糖化血红蛋白(Hb A_1c)、C反应蛋白(CRP)、血红蛋白(Hb)、白蛋白(ALB)、血尿素氮(BUN)、血肌酐(Scr)、尿肌酐(Ucr)、尿尿素氮(UUN)及24 h尿量等。结果880例患者在规律随访12个月后,糖尿病(DN)组及非糖尿病(非DN)组患者RRF均显著下降,DN组下降较非DN组更快(P<0.05)。DN组中非强化控制血糖组(Hb A_1c>7%)较强化血糖控制组(Hb A_1c<7%)RRF下降速率更快(P<0.05),而强化血糖控制组(Hb A_1c<7%)RRF下降速率与非DN组相近(P>0.05)。DN组中非强化血糖控制组(Hb A_1c≥7%)CRP较非DN组显著增高(P<0.05)。结论原发病为糖尿病的腹膜透析患者强化控制血糖可以更好地延缓RRF下降,而这种效应可能是通过控制腹膜透析患者的微炎症而达到的。

Objective To analyze the risk factors for peritoneal dialysis patients with diabetic nephropathy with residual renal function （RRF） declining. Methods Totally 880 cases of continuous ambulatory peritoneal dialysis （CAPD） patients were selected. There were 150 DN and 730 Non-DN patients. The level of HbAlc, CRP, Hb, ALB, BUN, SCr, UCr, UUN and 24h urine volume from the patients was detected. Results After 12 months＇ regular follow-up, RRF level of DN and non-DN group both got significantly decreased（P〈0.05）. Decrease of DN group was faster than that of non-DN group（P〈0.05）. In DN group, decrease non-intensive glucose control group （HbA1c〉7%）was faster than intensive glucose control group（HbA1c〈7%）（P〈0.05）,while it was similar between intensive glucose control group （HbA1c〈7%）and non-DN group（P〉0.05）. Meanwhile, CRP level in non-intensive glucose control group （HbA1c〉7%）of DN group was significantly higher than non-DN group（P〈0.05）. Conclusion Diabetic nephropathy peritoneal dialysis patients with intensive glucose control could delay decrease rate of RRF better, which might be due to micro-inflammation control on diabetic nephropathy peritoneal dialysis patients.