腹膜透析联合血液透析对尿毒症患者肾纤维化状态及血管、瓣膜动脉钙化的影响

Influence of Peritoneal Dialysis Combined with Hemodialysis on Renal Fibrosis Status and Vascular and Valve Calcification in Patients with Uremia

目的探究腹膜透析联合血液透析对尿毒症患者肾纤维化状态及血管、瓣膜钙化情况的影响。方法回顾性分析漯河市中心医院2021年1月至2022年1月收治的112例尿毒症患者临床资料,根据透析方式分为腹膜透析组(36例)、血液透析组(44例)及联合透析组(32例)。比较3组透析充分性[尿素清除指数(Kt/V)]、治疗前及治疗12个月后肾功能指标[尿素氮(BUN)、血肌酐(SCr)]、肾纤维化指标[结缔组织生长因子(CTGF)、骨形态发生蛋白-7(BMP-7)]、钙磷代谢指标[血钙、血磷、甲状旁腺激素(iPTH)]、颈动脉内膜中层厚度(CIMT)、血管钙化发生率以及治疗期间不良反应发生情况。结果血液透析组及联合透析组Kt/V均高于腹膜透析组,患者治疗后的BUN、SCr水平均低于腹膜透析组(P<0.05);血液透析组治疗后的CTGF、血钙、血磷、iPTH、CIMT及颈动脉钙化发生率均高于腹膜透析组和联合透析组,BMP-7水平低于腹膜透析组和联合透析组(P<0.05);血液透析组治疗期间肺动脉高压、充血性心力衰竭发生率均高于腹膜透析组及联合透析组(P<0.05)。结论相较于单一透析,腹膜联合血液透析在改善尿毒症患者钙磷代谢、肾纤维化及颈动脉钙化方面均有良好效果,且血管相关并发症较少,具备较高安全性。

Objective To explore the influence of peritoneal dialysis combined with hemodialysis on renal fibrosis status and vascular and valve calcification in patients with uremia.Methods Retrospective analysis of clinical data of 112 uremia patients admitted to Luohe Central Hospital from January 2021 to January 2022.According to the dialysis method,it was divided into peritoneal dialysis group(36 cases),hemodialysis group(44 patients)and combined dialysis group(32 cases).Dialysis adequacy[urea clearance index(Kt/V)],renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)],renal fibrosis indicators[connective tissue growth factor(CTGF),bone morphogenetic protein-7(BMP-7)],calcium-phosphorus metabolism indicators[blood calcium,blood phosphorus,intact parathyroid hormone(iPTH)],carotid intima-media thickness(CIMT)and incidence rate of vascular calcification before treatment and after 12 months of treatment and occurrence of adverse reactions during treatment were compared between the two groups.Results The Kt/V in hemodialysis group and combined dialysis group were higher than peritoneal dialysis group,and the BUN and SCr levels of patients were lower than those in peritoneal dialysis group(P<0.05).After treatment,the levels of CTGF,blood calcium,blood phosphorus,iPTH,CIMT and incidence rate of carotid artery calcification in hemodialysis group were higher than those in peritoneal dialysis group and combined dialysis group,while the BMP-7 level was lower than that in peritoneal dialysis group and combined dialysis group(P<0.05).The incidence rates of pulmonary hypertension and congestive heart failure in hemodialysis group were higher compared with those in peritoneal dialysis group and combined dialysis group(P<0.05).Conclusion Compared with single dialysis,peritoneal dialysis combined with hemodialysis has a better effect on improving the calcium-phosphorus metabolism,renal fibrosis and carotid artery calcification in patients with uremia,and the latter one has fewer vascular related complications and higher safety.