维持性血液透析与持续不卧床腹膜透析对终末期肾病患者钙磷代谢及氧化应激的影响比较

Comparison of the effect of maintenance hemodialysis and continuous ambulatory peritoneal dialysis on calcium and phosphorus metabolism and oxidative stress in patients with end-stage renal disease

目的探讨维持性血液透析与持续不卧床腹膜透析对终末期肾病患者钙磷代谢及氧化应激的影响。方法选择2019年1月至2021年10月南阳市中心医院肾内科收治的120例行透析治疗的终末期肾病患者为研究对象,按照随机数字表法将患者分为对照组和观察组,每组60例。对照组患者采用维持性血液透析治疗,观察组患者采用持续不卧床腹膜透析治疗,2组患者均连续治疗3个月。透析治疗前及连续透析治疗3个月后,使用全自动生物化学分析仪检测2组患者的血清钙、磷水平,采用硫代巴比妥酸法检测2组患者血清中丙二醛(MDA)水平,采用黄嘌呤氧化酶法检测2组患者血清中超氧化物歧化酶(SOD)水平,采用比色法检测2组患者血清中髓过氧化物酶(MPO)水平。比较2组患者连续透析治疗3个月后血清钙、磷达标率及透析治疗期间消化道出血、动静脉内瘘闭塞、感染、低蛋白血症及心功能异常等并发症发生情况。结果透析治疗前,2组患者血清钙、磷及MDA、SOD、MPO水平比较差异均无统计学意义(P>0.05)。透析治疗3个月后,2组患者的血清钙水平及对照组患者的血清磷水平与透析治疗前比较差异无统计学意义(P>0.05),观察组患者的血清磷水平显著低于透析治疗前(P<0.05)。透析治疗3个月后,2组患者的血清钙水平比较差异无统计学意义(P>0.05),观察组患者的血清磷水平显著低于对照组(P<0.05)。对照组患者血清钙达标35例(58.33%),血清磷达标16例(26.67%);观察组患者血清钙达标38例(63.33%),血清磷达标31例(51.67%);2组患者血清钙达标率比较差异无统计学意义(χ^(2)=0.315,P>0.05),观察组患者血清磷达标率显著高于对照组(χ^(2)=7.869,P<0.05)。透析治疗3个月后,2组患者血清中MDA、MPO水平显著高于透析治疗前(P<0.05),SOD水平显著低于透析治疗前(P<0.05)。透析治疗3个月后,观察组患者血清中MDA、MPO水平显著低于对照组(P<0.05),SOD水平显著高于对照组(P<0.05)。透析治疗期间,对照组患者发生消化道出血4例(6.67%),动静脉内瘘闭塞3例(5.00%),感染2例(3.33%),低蛋白血症4例(6.67%),心功能异常5例(8.33%),并发症发生率为30.00%(18/60);观察组患者发生消化道出血2例(3.33%),动静脉内瘘闭塞1例(1.67%),感染1例(1.67%),低蛋白血症1例(1.67%),心功能异常2例(3.33%),并发症发生率为11.67%(7/60);观察组患者并发症发生率显著低于对照组(χ^(2)=6.114,P<0.05)。结论维持性血液透析和持续不卧床腹膜透析对终末期肾病患者血清钙代谢的影响无显著差异,而持续不卧床腹膜透析对终末期肾病患者血清磷的控制效果更好,诱发患者机体的氧化应激反应相对更轻微,安全性更高。

Objective To investigate the effect of maintenance hemodialysis and continuous ambulatory peritoneal dialysis on calcium and phosphorus metabolism and oxidative stress in patients with end-stage renal disease.Methods A total of 120 patients with end-stage renal disease who received dialysis treatment in the Department of Nephrology of Nanyang Central Hospital from January 2019 to October 2021 were selected as the research objects,and the patients were divided into the control group and the observation group according to the random number table method,with 60 cases in each group.The patients in the control group were treated with maintenance hemodialysis,and patients in the observation group were treated with continuous ambulatory peritoneal dialysis,the patients in the both groups were treated for 3 months.Before dialysis treatment and after 3 months of continuous dialysis treatment,the serum calcium and phosphorus levels of the patients in the two groups were detected by the automatic biochemical analyzer,the serum malondialdehyde(MDA)level was detected by the thiobarbituric acid method,the serum superoxide dismutase(SOD)level was detected by the xanthine oxidase method,the serum myeloperoxidase(MPO)level was detected by the colorimetric method.The rate of serum calcium and phosphorus reaching the standard before dialysis treatment and after 3 months of continuous dialysis treatment between the two groups were compared,the complications such as hemorrhage of digestive tract,arteriovenous fistula occlusion,infection,hypoalbuminemia and abnormal cardiac function during dialysis treatment were compared between the two groups.Results There was no significant difference in serum calcium,phosphorus,MDA,SOD and MPO levels of patients between the two groups before dialysis treatment(P>0.05).After 3 months of dialysis treatment,there was no significant difference in the serum calcium level of patients between the two groups(P>0.05).There was no significant difference in serum phosphorus level of patients before dialysis treatment and after 3 months of dialysis treatment in the control group(P>0.05).The serum phosphorus level of patients in the observation group after 3 months of dialysis treatment was significantly lower than that before dialysis treatment(P<0.05).There was no significant difference in serum calcium level of patients between the two groups after 3 months of dialysis treatment(P>0.05).After 3 months of dialysis treatment,the serum phosphorus level of patients in the observation group was significantly lower than that in the control group(P<0.05).In the control group,35 cases(58.33%)reached the standard of the serum calcium,and 16 cases(26.67%)reached the standard of the serum phosphorus;in the observation group,38 cases(63.33%)reached the standard of serum calcium,and 31 cases(51.67%)reached the standard of the serum phosphorus;there was no significant difference in the rate of reaching the standard of serum calcium between the two groups(χ^(2)=0.315,P>0.05);the serum phosphorus compliance rate in the observation group was significantly higher than that in the control group(χ^(2)=7.869,P<0.05).After 3 months of dialysis treatment,the serum MDA and MPO levels of patients were significantly higher than those before dialysis treatment in the two groups(P<0.05),and the SOD level of patients was significantly lower than that before dialysis treatment(P<0.05).After 3 months of dialysis treatment,the serum MDA and MPO levels of patients in the observation group were significantly lower than those in the control group(P<0.05),and the serum SOD level of patients was significantly higher than that in the control group(P<0.05).During dialysis treatment,hemorrhage of digestive tract occurred in 4 cases(6.67%),arteriovenous fistula occlusion in 3 cases(5.00%),infection in 2 cases(3.33%),hypoalbuminemia in 4 cases(6.67%),abnormal cardiac function in 5 cases(8.33%),and the incidence of complication was 30.00%(18/60)in the control group;in the observation group,hemorrhage of digestive tract occurred in 2 cases(3.33%),arteriovenous fistula occlusion in 1 case(1.67%),infection in 1 case(1.67%),hypoproteinemia in 1 case(1.67%),cardiac dysfunction in 2 cases(3.33%),and the incidence of complications was 11.67%(7/60);the incidence of complications in the observation group was significantly lower than that in the control group(χ^(2)=6.114,P<0.05).Conclusion The effect of maintenance hemodialysis on the serum calcium metabolism of patients with end-stage renal disease has no significant difference compared with that of continuous ambulatory peritoneal dialysis,but continuous ambulatory peritoneal dialysis has better control for serum phosphorus in patients with end-stage renal disease,and the oxidative stress reaction of patients caused by continuous ambulatory peritoneal dialysis is relatively mild,it has higher security.