腹膜炎对CAPD患者腹膜小分子物质转运与超滤功能的影响

Longitudinal Study of Peritonitis on Peritoneal Function in CAPD Patients

目的 :观察了腹透时间、腹膜炎对连续非卧床腹膜透析 (CAPD)患者腹膜转运与超滤功能的影响。方法 :观察对象为 1998年～ 2 0 0 1年在我透析中心行CAPD患者 10 1例 ,其中发生腹膜炎者 12例 ,为观察组 ;无腹膜炎发作史者 89例 ,为对照组。于开始腹透后第 1、6、12、18、2 4月分别进行腹膜平衡实验 (PET) ,用于评价腹膜的小分子溶质转运 (D/Pcreat)及超滤能力 (UF)。结果 :在无腹膜炎发作史的 89例患者中 ,其D/Pcreat比值随腹透的进行而逐渐缓慢上升 ,至 12个月时达到最大值 (0 .6 5± 0 .0 5 ) ,与透析第 1个月相比无显著性差异 (0 .6 1± 0 .0 6 ,P =0 .0 6 5 ) ;在伴有腹膜炎发作史者 ,其D/Pcreat比值上升幅度较大 ,并于腹透的第 12个月也达到高峰值 (0 .74± 0 .0 5 6 ) ,与对照组相比有显著性差异 (P <0 .0 5 ) ;在开始CAPD后 ,所有患者超滤量 (UF)随透析时间延长 ,呈快速下降过程 ,特别是在伴有腹膜炎发作史的患者更为明显。无腹膜炎发作史的患者于透析第 18个月达到最低水平 (35 1± 4 8ml) ,与透析第 1个月相比有显著性差异 (382± 4 2ml,P <0 .0 5 ) ,而伴有腹膜炎发作史的患者则于开始透析后的第 12个月达最低水平(32 6± 5 7ml) ,两组的差别具有统计学意义 (P <0 .0 5 )。经线性回归分析 ,累积?

Objective:To evaluate the longitudinal effects of peritoneal dialysis, peritonitis on peritoneal membrane function in CAPD(continuous ambulatory peritoneal dialysis) patients. Methods:101 patients in our dialysis center were engaged in this study.12 of them had peritonitis during CAPD treatment.Peritoneal equilibration test (PET) was utilized to quantify longitudinal changes in low-molecular-weight transfer (D/Pcreat) and ultrafiltration volume (UF).PET was performed at 1,6,12,18, and 24 months after CAPD therapy.Results: D/Pcreat ratios in patients without peritonitis episodes were slightly increased and reached to the top values at 12th month after of CAPD(0.65±0.05, P =0.065 vs that at the first month).But there was a rapid increase of D/Pcreat ratios in patients with peritonitis episodes, which also reached the top value at the 12th month after CAPD(0.74±0.056, P <0.05 vs that in patients without peritonitis episodes).Although there was a slow decrease of D/Pcreat ratios during the following 12 months in both groups, but the values were still higher than what of the first month in control group( P = 0.068 ).No significant difference of the D/Pcreat ratios between these two groups was observed at the 24th month of CAPD.As for the ultrafiltration value(UF), there was a significant and rapid decrease in all patients during CAPD treatment, especially in patients with peritonitis episodes.UF in the patients without peritonitis episodes reached the lowest at the 18th month of CAPD(360±48 ml, P <0.05 vs the one at the first month), but for the one with peritonitis episodes, the lowest UF was observed at the 12th month from the beginning of CAPD(326±57 ml, P <0.05 vs that in patients without peritonitis episodes).On the basis of linear regression analysis, it is suggested that there was a positive relationship between cumulative days of peritonitis and D/Pcreat ratios( r =0.83).However, a negative relationship between cumulative days of peritonitis and UF was observed ( r =-0.75).Conclusion:In our study, it is suggested that conventional CAPD might result in negative effects to peritoneal functions, especially for small molecular solute transfer and ultrafiltration volume,and peritonitis may impose an additional damages to the peritoneal functions,in patients under CAPD treatment.