血液透析和腹膜透析对非糖尿病肾病患者黄斑区血流密度及形态学的影响

Effects of Hemodialysis and Peritoneal Dialysis on Macular Blood Flow Density and Morphology in Patients with Non-diabetic Nephropathy

目的:探讨血液透析和腹膜透析对非糖尿病肾病患者黄斑区血流密度及形态学的影响。方法:分析本院132例2020年1月至2021年3月收治的需要进行透析治疗的非糖尿病肾病患者,按透析方式分为血液透析组65例、腹膜透析组67例。检测并比较两组患者透析前后的血红蛋白(Hemoglobin,Hb)、血清白蛋白(Serum Albumin,SAB)、血清肌酐(Serum Creatinine,Scr)、血尿素氮(Blood Urea Nitrogen,BUN)、白细胞介素-6(Interleukin-6,IL-6)和超敏C反应蛋白(High-Sensitivity C-Reactive Protein,hs-CRP),通过光学相干断层扫描血管成像(Optical Coherence Tomography Angiography,OCTA)扫描分析6 mm×6 mm黄斑区范围,检查内视网膜表层、中层、深层毛细血管丛血流密度、FD300血流密度、黄斑中心凹无血管区(Foveal Avascular Zone,FAZ)面积、FAZ周长、非圆度指数(A-circularity index,AI)等指标以及两组患者并发症发生情况。结果:①透析前两组患者Hb、SAB、Scr、BUN差异均无统计学意义(P>0.05),透析后两组患者Hb、SAB均高于透析前(P<0.05),Scr、BUN均低于透析前(P<0.05),且腹膜透析组Hb、SAB透析前后差值均低于血液透析组(P>0.05),Scr、BUN透析前后差值均高于血液透析组(P<0.05);②透析前两组患者IL-6、hs-CRP差异均无统计学意义(P>0.05),透析后两组患者炎症指标IL-6、hs-CRP均低于透析前(P<0.05),且腹膜透析组透析前后IL-6、hs-CRP差值低于血液透析组(P<0.05);③透析前两组患者内视网膜表层、中层、深层及FD300血流密度差异均无统计学意义(P>0.05),透析后两组内视网膜表层、中层、深层及FD300血流密度均高于透析前(P<0.05;),且腹膜透析组透析前后内视网膜表层、中层、深层、FD300血流密度差值均低于血液透析组(P<0.05);④透析前,两组患者FAZ面积、FAZ周长、AI差异均无统计学意义(P>0.05),血液透析组透析后FAZ面积、FAZ周长、AI较透析前差异均无统计学意义(P>0.05),腹膜透析组透析后FAZ周长低于透析前(P<0.05),AI高于透析前(P<0.05),腹膜透析组透析前后FAZ面积、FAZ周长、AI差值均高于血液透析组(P<0.05)。⑤腹膜透析组发热发生率显著低于血液透析组(P<0.05),但两组低血压、低血糖、腹膜炎、脑水肿及病死率无显著差异(P>0.05)。结论:对于非糖尿病肾病患者,血液透析和腹膜透析均可以有效改善患者营养状态,较血液透析,腹膜透析对肾功能的改善效果更好,能降低内视网膜中层、内视网膜深层血流密度,但产生的炎症因子较多,导致FAZ形态学改变,AI增大,临床治疗应多方面综合考虑选择适合患者的透析方案。

Objective:To explore the effects of hemodialysis and peritoneal dialysis on macular blood flow density and morphology in patients with non-diabetic nephropathy(NDN).Methods:A total of 132 patients with NDN who needed to be treated with dialysis and admitted to the hospital between January 2020 and March 2021 were selected.According to the dialysis modality,they were divided into hemodialysis group(65 cases)and peritoneal dialysis group(67 cases).The levels of hemoglobin(Hb),serum albumin(SAB),serum creatinine(Scr),blood urea nitrogen(BUN),interleukin-6(IL-6)and high-sensitivity C-reactive protein(hs-CRP)were detected and compared between the two groups before and after dialysis.The range of 6 mm×6 mm macular area was analyzed by optical coherence tomography angiography(OCTA).The blood flow density of retinal surface,middle and deep capillary plexus,blood flow density of FD300,area and circumference of central macular foveal avascular zone(FAZ),A-circularity index(AI),and the occurrence of complications in the two groups were examined.Results:①There was no statistically significant difference in Hb,SAB,Scr,and BUN between the two groups before dialysis(P>0.05).After dialysis,Hb and SAB in the two groups were higher than those before dialysis(P<0.05),Scr and BUN were lower than those before dialysis(P<0.05).The differences of Hb and SAB before and after dialysis in the peritoneal dialysis group were lower than those in the hemodialysis group(P>0.05).The differences of Scr and BUN were higher than those in the hemodialysis group(P<0.05).②There was no statistically significant difference in IL-6 and hs-CRP between the two groups before dialysis(P>0.05).After dialysis,IL-6 and hs-CRP in the two groups were lower than those before dialysis(P<0.05),and the differences in peritoneal dialysis group were lower than those in the hemodialysis group(P<0.05).③There was no statistically significant difference in blood flow densities of the inner retina surface layer,middle layer,deep layer and FD300 between the two groups before dialysis(P<0.05).After dialysis,the blood flow densities in the two groups were higher than those before dialysis(P<0.05),and the differences in peritoneal dialysis group were lower than those in the hemodialysis group(P<0.05).④There was no statistically significant difference in area and circumference of FAZ,and AI between the two groups before dialysis(P>0.05).The area and circumference of FAZ,and AI in the hemodialysis group showed no statistically significant difference before and after dialysis(P>0.05).After dialysis,the circumference of FAZ in the peritoneal dialysis group was smaller than that before dialysis(P<0.05),and AI was higher than that before dialysis(P<0.05).The differences of area and circumference of FAZ,and AI before and after dialysis in the peritoneal dialysis group were higher than those in the hemodialysis group(P<0.05).⑤The incidence of fever in peritoneal dialysis group was significantly lower than that in hemodialysis group(P<0.05).However,there was no significant difference in the incidence rates of hypotension,hypoglycemia,peritonitis and cerebral edema,and fatality rate between the two groups(P>0.05).Conclusion:For patients with non-diabetic nephropathy,both hemodialysis and peritoneal dialysis can effectively improve their nutritional status.Compared with hemodialysis,peritoneal dialysis can better improve renal function and reduce blood density of retinal middle and deep layers.However,it induces more inflammatory factorsand increases AI.Clinically,the dialysis plan should be determined after comprehensive consideration.