残余肾功能对腹膜透析患者营养状况影响的临床研究

Clinical study of the effects of residual renal function on nutritional status of patients with peritoneal dialysis

目的 前瞻性观察长期持续性非卧床腹膜透析 (CAPD ,简称腹透 )患者的营养状况 ,探讨残余肾功能对营养状况的影响。方法 选择腹透时间大于 3个月的慢性肾功能衰竭患者 37例作为实验组 ,10例健康人作为正常对照组。实验组以残余肾肌酐清除率 3ml/min为界 ,分A组 [残余肾功能 (RRF) <3ml/min],32例次 ;B组 (RRF≥ 3ml/min) ,2 1例次。采用常规处方透析 ,留取尿液、腹透液 ,并抽血检测生化、血脂及蛋白营养指标 ,计算RRF、KT/V值、肌酐清除率 (Ccr)、单位透析剂量 (PV/S)及蛋白质分解率 (PCR) ,评估每日蛋白质摄入量 (DPI)。结果 RRF与KT/V、Ccr及残余尿量呈正相关 (r =0 .5 6、0 .83及 0 .80 ,P均 <0 .0 5 ) ,与透析时间、透析超滤量呈负相关 (r =- 0 .4 1、0 .33,P均 <0 .0 5 ) ,与PV/S不相关。A组Ccr、KT/V及血浆前白蛋白(PA)、视黄醇结合蛋白 (RBP)、转铁蛋白 (Tf)明显低于B组 ,但PCR高于B组。A、B两组间白蛋白、三酰甘油及胆固醇的差异无显著性 (P >0 .0 5 )。结论 RRF与腹膜透析的充分性密切相关 ,并影响腹透患者的营养状况 ,根据RRF下降程度及时调整透析剂量及方案 。

Objective To observe the nutritional status of patients with continuous ambulatory peritoneal dialysis (CAPD) prospectively and to investigate the influence of residual renal function (RRF). Methods Urine and peritoneal dialysate of patients with dialysis were collected and serum urea nitrogen (BUN), creatinine (Scr), lipid, albumin were measured to calculate RRF, KT/V, creatinine clearance (Ccr)rate, PV/S and protein catabolic rate (PCR) to evaluate the daily protein intake (DPI).Results RRF was correlated positively with KT/V, Ccr and volume of residual urine ( r =0.56, 0.83, 0.80 respectively, P <0.05), but negatively with dialyzing duration, ultrafiltration rate ( r =-0.41 and -0.33 respectively, P<0.05 ), and no correlation with PV/S. Compared with patients in group B (RRF≥3 ml/min), the level of Ccr, KT/V, prealbumin (PA), retinol binding protein (RBP) and transferrin (TF) were significantly lower in group A (RRF<3 ml/min) while the PCR was higher. However, no significant difference was found in Alb、TG and Tch between both groups.Conclusion RRF is closely related with the adequacy of peritoneal dialysis and will affect the nutritional status in patients with CAPD. The most essential way to prevent malnutrition in patients with CAPD is to adjust promptly the prescripition of dialyzing fluid based on their RRF.