腹膜透析和血液透析对尿毒症患者肾功能及并发症的影响研究

Effect of peritoneal dialysis and hemodialysis on renal function and complications in uremic patients

目的:探讨腹膜透析(PD)和血液透析(HD)对尿毒症患者肾功能及并发症的影响。方法:采用数表法,将96例接受透析治疗的尿毒症患者随机分为PD组和HD组,每组各48例。分别于治疗前、透析3个月后检测血清肌酐(SCr)、尿素氮(BUN)、超敏C-反应蛋白((hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和降钙素原(PCT)等指标,统计两组并发症发生情况。结果:透析3个月后,两组患者的血清SCr、BUN、hs-CRP、IL-6、TNF-α和PCT水平均较透析前明显下降( P <0.05);两组患者SCr、BUN、IL-6、TNF-α和PCT水平与透析前比较,差异无统计学意义( P >0.05)。透析后,PD组患者的hs-CRP水平低于HD组,差异有统计学意义( P <0.05);PD组的感染发生率(16.67%)、低蛋白血症发生率(20.83%)分别高于HD组的4.17%、4.17%;PD组的高血压发生率(10.42%)、心律失常发生率(6.25%)和充血性心衰发生率(12.50%)明显低于HD组的29.17%、22.92%、35.42%,差异均有统计学意义( P <0.05)。结论: PD和HD均是保护尿毒症患者残余肾功能的有效透析模式,并发症方面也各有优势和不足,但PD对降低hs-CRP水平效果更为显著,可考虑作为尿毒症患者主要透析方式。

Objective: To investigate the effects of peritoneal dialysis(PD) and hemodialysis(HD) on renal function and complications in uremic patients. Methods: 96 uremic patients were randomly divided into PD group and HD group,with 48 cases in each group.Serum creatinine(SCr),blood urea nitrogen(BUN),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6) and procalcitonin(PCT) were measured before treatment and 3 months after dialysis.The incidence of complications in the two groups was counted. Results: After 3 months of dialysis,the levels of serum SCr,BUN,hs-CRP,IL-6,TNF-α and PCT in the two groups were significantly lower than those before dialysis( P <0.05),there was no significant difference in the levels of SCr,BUN,IL-6,TNF-α and PCT between the two groups before dialysis( P >0.05).After dialysis,the level of hs-CRP in PD group was lower than that in HD group( P <0.05),the incidence of infection(16.67%) and hypoproteinemia(20.83%) in PD group were higher than that in HD group(4.17%,4.17%),respectively.The incidence of hypertension(10.42%),arrhythmia(6.25%) and congestive heart failure(12.50%) in the PD group were significantly lower than those in the HD group(29.17%,22.92%,35.42%) with statistical significance( P <0.05). Conclusion: Both PD and HD are effective dialysis modes to protect the residual renal function of uremic patients,and their complications have their own advantages and disadvantages.However,PD is more effective in reducing the level of hs-CRP,which can be considered as the main dialysis mode for uremic patients.