血液透析与腹膜透析治疗老年人终末期肾病的效果比较

Comparison of the effects of hemodialysis and peritoneal dialysis for elderly patients with end-stage renal disease

目的比较血液透析（HD）与腹膜透析（PD）治疗老年人终末期肾病的效果及对患者生存率的影响。方法回顾性分析宁波市北仑区人民医院2013年3月至2015年4月治疗的老年终末期肾病患者100例的临床资料，根据透析方式不同分为两组，HD组50例采用HD治疗，PD组50例采用PD治疗。观察两组透析治疗前后炎性因子水平、肾功能、营养指标和脂代谢水平，比较两组患者2年生存率。结果两组患者治疗前炎性因子水平差异均无统计学意义；治疗后，HD组白细胞介素18（IL-18）[（56.22±7.32）mg/L]、IL-6[（12.18±2.03）mg/L]和超敏C反应蛋白（hs-CRP）[（8.54±1.12）mg/L]水平均低于PD组[（78.46±7.28）mg/L、（15.23±2.25）mg/L、（10.23±1.67）mg/L]（t＝15.233、7.117、5.943，均P〈0.001）；治疗后，HD组BUN[（6.22±1.05）mmol/L]、SCr[（115.44±10.84）μmol/L]水平均低于PD组[（8.87±1.22）mmol/L、（134.52±15.23）μmol/L]（t＝5.943、7.217，均P〈0.001），肾小球滤过率（GFR）[（8.15±13.35）mL/min]水平高于PD组[（9.26±12.58）mL/min]（t＝－4.969，P〈0.001）。两组治疗前营养指标差异均无统计学意义，治疗后，HD组血清白蛋白（ALB）[（53.62±4.13）g/L]、血清前白蛋白（PA）[（342.15±15.02）mg/L]和血红蛋白（Hb）[（115.86±10.02）g/L]水平均高于PD组[（45.95±5.57）g/L）、（228.36±12.23）mg/L、（98.02±7.12）g/L]（t＝－7.821、－41.541、－10.263，均P〈0.001）；两组治疗前脂代谢指标差异均无统计学意义，治疗后，HD组总胆固醇（TC）[（4.78±0.98）mmol/L]、低密度脂蛋白（LDL）[（2.51±0.97）mmol/L]水平均低于PD组[（5.53±1.02）mmol/L、（2.89±1.03）mmol/L]（t＝3.749、1.899，均P〈0.05），高密度脂蛋白（HDL）[（1.39±0.46）mmol/L]水平高于PD组[（1.22±0.34）mmol/L]（t＝－2.101，P〈0.001）；HD组2年生存率为96.00%，PD组2年生存率为86.00%，两组2年生存率差异无统计学意义（P〉0.05）。结论与PD相比，HD对老年终末期肾病患者有较好的治疗效果，可明显改善代谢水平，提高患者生存率。

Objective To compare the effects of hemodialysis（HD） and peritoneal dialysis（PD） in the treatment of elderly patients with end-stage renal disease.Methods The clinical data of 100 elderly patients with end-stage renal disease who were treated in the People＇s Hospital of Beilun District from March 2013 to April 2015 were retrospectively analyzed.The patients were divided into HD group and PD group according to the treatment Methods , with 50cases in each group.The 2-year survival rate of the patients in the two groups was observed, and the differences of renal function, nutritional index and lipid metabolism were compared between the two groups before and after treatment.Results Before treatment, there were no statistically significant differences between the two groups in the levels of proinflammatory cytokines.After treatment, the levels of IL-18[（56.22±7.32）mg/L], IL-6[（12.18±2.03）mg/L] and hs-CRP[（8.54±1.12）mg/L] in the HD group were lower than those in the PD group[（78.46±7.28）mg/L, （15.23±2.25）mg/L, （10.23±1.67）mg/L]（t=15.233, 7.117, 5.943, all P〈0.001）. After treatment, the levels of BUN[（6.22±1.05）mmol/L], SCr[（115.44±10.84）μmol/L] in the HD group were lower than those in the PD group[（8.87±1.22）mmol/L, （134.52±15.23）μmol/L] （t=5.943, 7.217, all P〈0.001）, the GFR[（8.15±13.35）mL/min] of the HD group was higher than that of the PD group[（9.26±12.58）mL/min] （t=-4.969, P〈0.001）. Before treatment, the nutrition indicators between two groups had no statistically significant difference.After treatment, the levels of ALB[（53.62±4.13）g/L], PA[（342.15±15.02）mg/L] and Hb[（115.86±10.02）g/L] in the HD group were higher than those in the PD group [（45.95±5.57）g/L, （228.36±12.23）mg/L, （98.02±7.12）g/L]（t=-7.821, -41.541, -10.263, all P〈0.001）. Before treatment, the lipid metabolism indicators between the two groups had no statistically significant differences（all P〉0.05）. After treatment, the levels of TC[（4.78±0.98）mmol/L], LDL[（2.51±0.97）mmol/L] in the HD group were lower than those in the PD group[ （5.53±1.02）mmol/L, （2.89±1.03）mmol/L] （t=3.749, 1.899, all P〈0.05）, the level of HDL[（1.39±0.46）mmol/L] of the HD group was higher than that of the PD group [（1.22±0.34）mmol/L]（t=-2.101, P〈0.001）. The 2-year survival rate in the HD group was 96.00%, and that in the PD group was 86.00%.There was no statistically significant difference between the two groups in the 2-year survival rate（P〉0.05）.Conclusion HD has better therapeutic effect on elderly patients with end-stage renal disease, it can significantly improve the metabolic level of patients and improve the survival rate of patients.