腹膜透析和血液透析对尿毒症合并高尿酸血症患者微炎症及痛风发作的影响

Effects of peritoneal dialysis and hemodialysis on microinflammation and gout attack in patients with uremia complicated with hyperuricemia

目的研究腹膜透析和血液透析对尿毒症合并高尿酸血症患者微炎症及痛风发作的影响。方法选取湖北医药学院附属随州医院收治的尿毒症合并高尿酸血症患者98例,其中接受血液透析51例(HD组),接受腹膜透析47例(PD组),随访6个月,根据患者是否有痛风性关节炎急性发作分为发作组(A组)和未发作组(NA组),按照其发生次数分为0次、1或2次、3或4次、≥5次4个等级,分别比较HD组与PD组、A组与NA组微炎症因子水平,并比较HD组和PD组患者急性痛风性关节炎急性发作例数的差异。结果PD组体内微炎症因子水平低于HD组患者体内微炎症水平(P<0.05);A组患者体内微炎症因子平均水平较NA组患者高(P<0.05);PD组痛风性关节炎急性发作例数低于HD组(P<0.05)。结论腹膜透析相较血液透析可降低尿毒症合并高尿酸血症患者痛风急性发作的风险,其可能机制为腹膜透析患者体内微炎症水平远低于血液透析患者。

Objective To study the effects of peritoneal dialysis and hemodialysis on microinflammation and gout attack in patients with uremia complicated with hyperuricemia.Methods Totally 98 patients with uremia complicated with hyperuricemia were enrolled,including 51 patients undergoing hemodialysis(HD group)and 47 patients receiving peritoneal dialysis(PD group).All patients were followed up for 6 months.According to whether the patient had acute gouty arthritis,patients were divided into seizure group(group A)and non-seizure group(NA group);according to the number of occurrences,it is divided into four levels:0 time,1 to 2 times,3 to 4 times,≥5 times.The levels of microinflammatory factors were compared between HD group and PD group,A group and NA group;and the number of patients with acute gouty arthritis in HD group and PD group were compared.Results After 6 months of follow-up,the level of microinflammation factor in PD was significantly lower than that in HD group(P<0.05).The average level of microinflammation factor in group A was higher than that in group NA(P<0.05).The incidence of acute gouty arthritis in PD group was lower than that in HD group,and the difference was statistically significant(P<0.05).Conclusion Peritoneal dialysis can reduce the risk of acute gout in patients with uremia complicated with hyperuricemia compared with hemodialysis.The possible mechanism is that the level of microinflammation in peritoneal dialysis patients is much lower than that in hemodialysis patients.