腹膜透析患者葡萄糖吸收与蛋白丢失及残余肾功能的相关性研究

Association of Glucose Absorption with Protein Loss and Residual Renal Function in Peritoneal Dialysis Patients

目的探讨腹膜透析患者葡萄糖吸收与营养状况、蛋白质丢失以及残余肾功能的相关性。方法采用前瞻性队列研究,选取2013~2017年在武汉同济医院肾内科进行持续性非卧床腹膜透析患者,共132例。每隔半年检测患者的血清、24h尿液及24h透析液中的生化指标和葡萄糖吸收量,计算患者平均葡萄糖吸收率。以葡萄糖吸收率四分位间距将患者分为4组,采用单因素方差分析和独立样本Kruskal-Wallis H检验比较每组患者最近半年血液、24h尿液和24h透析液中生化指标的差异。采用平滑曲线拟合上述有统计学差异的指标与葡萄糖吸收率的相关性。结果研究发现葡萄糖吸收率与血清白蛋白(P=0.005)、24h尿肌酐(P=0.049)、超滤量(P<0.01)呈负相关,而与血清碳酸氢根(P<0.01)、24h透析液中蛋白质(P=0.007)、白蛋白(P=0.002)以及肌酐(P<0.01)水平呈正相关。结论腹膜透析患者葡萄糖吸收率与蛋白丢失、超滤量、血清碳酸氢根以及尿肌酐水平密切相关。葡萄糖吸收负荷过大将加重患者腹膜蛋白丢失、血浆蛋白减少,从而导致水潴留而超滤减少,这可能间接反映了葡萄糖过量吸收影响腹膜透析患者的临床结局。

Objective To explore the correlation between glucose absorption and nutritional status,protein loss and residual renal function in patients with peritoneal dialysis.Methods A prospective cohort study was conducted by recruiting 132 patients without diabetes mellitus and infection at the initiation of peritoneal dialysis.The demographic characteristics,nutritional markers and the biochemical parameters in serum,24-h urine and effluent dialysis liquid were collected.The correlation between average glucose absorption rate and variables above was analyzed by smooth curve fitting.Results The glucose absorption rate was positively correlated with serum bicarbonate（P〈0.01）,protein（P=0.007）,albumin（P=0.002）and creatinine（P〈0.01）in effluent dialysis liquid,while negatively associated with serum albumin（P=0.005）,24-h urinary creatinine（P=0.049）and ultrafiltration volume（P〈0.01）. Conclusion The glucose absorption rate is correlated closely with protein loss,ultrafiltration quantity,serum bicarbonate radical and urinary creatinine.High glucose absorption will aggregate peritoneum protein loss,decrease plasma protein,thus lead to water retention and decrease of ultrafiltration,indirectly indicating excessive absorption of glucose influences clinical outcome of peritoneal dialysis.