中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (04): 219-225.doi: 10.3969/j.issn.1671-4091.2016.04.008

• 临床研究 • 上一篇    下一篇

透析方式对非糖尿病终末期肾病患者临床指标及胰岛素抵抗影响的比较

曾海鸥1,陈圳炜1,罗敏虹1,袁丽萍1,伍强1,何东玲1,杨铁城1   

  1. 广东医学院附属深圳市第四人民医院
  • 收稿日期:2015-11-23 修回日期:2016-02-06 出版日期:2016-04-12 发布日期:2016-04-19
  • 通讯作者: 杨铁城 xiaoou24@qq.com E-mail:yangtcpro@163.com
  • 基金资助:

    深圳市福田区卫生公益性科研项目(NO.FTWS201309)

Dialysis modality on clinical indicators and insulin resistance in non-diabetic patients with end-stage renal disease

  • Received:2015-11-23 Revised:2016-02-06 Online:2016-04-12 Published:2016-04-19

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摘要： 目的比较血液透析(hemodialysis, HD)及腹膜透析(peritoneal dialysis, PD)对非糖尿病终末期肾病(end stage renal disease, ESRD)患者临床指标及胰岛素抵抗(insulin resistance,IR)的影响，为非糖尿病ESRD 患者透析方式选择及临床综合治疗提供参考。方法2012 年9 月至2014年2 月在深圳市第四人民医院住院的成人(年龄＞18 岁)非糖尿病ESRD 患者，血压控制平稳(小于140/90mmHg)准备行透析治疗，随机分成HD 组(n=32)及PD 组(n=30)。透析前、透析后6 月、透析后12 月分别检测相关临床指标，包括体质量指数(body mass index, BMI)、腹围(abdominal circumference，AC)、血红蛋白(hemoglobulin，HGB)、超敏C 反应蛋白(hypersensitive C- reactive protein，hsCRP)、尿素氮(blood urea nitrogen，BUN)、肌酐(serum creatinine，Scr)、尿酸(uric acid，UA)、血钙(calcium，Ca)、血磷(phosphorous，P)、血钙磷乘积(Ca×P)、全段甲状旁腺素(intact parathyroid hormone,iPTH)、血清白蛋白(albumin，ALB)、三酰甘油(triglyceride，TG)、总胆固醇(total cholesterol，TC)、低密度脂蛋白(low density lipoprotein，LDL)、高密度脂蛋白(high density lipoprotein，HDL)、糖化血红蛋白A1C(HbAlC)、空腹血糖(fasting blood glucose，FBG)、空腹真胰岛素(fasting insulin，FINS)，评估患者IR 指数(insulin resistance index, IRI)。比较HD 及PD 对临床指标及IR 的影响。结果①透析治疗前，上述临床指标HD 组与PD 组的组间比较均无统计学意义；透析治疗6 月后，HD 组与PD 组相比，hsCRP[(6.91 ± 4.75)mg/L 比(4.20 ± 3.68)mg/L，t=2.494，P=0.015]、ALB[(33.07 ± 2.10)g/L 比(30.31±3.47)g/L，t=3.851，P=0.000]HD 组患者较PD 组患者高，而Ca[(2.27±0.15)mmol/L 比(2.43±
0.15) mmol/L，t=-4.150，P=0.000]、Ca×P[(57.38±7.17)mg2/dl2 比(61.49±7.83)mg2/dl2，t=-2.159，P=0.035]、TC[(4.94 ± 0.72)mmol/L 比(5.50 ± 1.04 mmol/L, t=- 2.482, P=0.016]、TG[(1.52 ± 0.40)mmol/L 比(1.87±0.72)mmol/L，t=-2.351，P=0.023]、LDL[(2.62±0.54)mmol/L 比(3.08±0.57)mmol/L，t=-3.294，P= 0.002]、HDL[(1.08±0.20)mmol/L 比(1.29±0.26)mmol/L，t=-3.667，P=0.001]HD 组患者低于PD 组患者，组间比较差异有统计学意义；透析治疗12 月后，HD 组与PD 组相比，HGB[(110.94±14.50)g/L 比(102.03 ± 15.53)g/L，t=2.334，P=0.023]、hsCRP[(6.00(1.00～14.00)mg/L 比3.00(1.00～27.00)mg/L，t=2.911, P= 0.005]、ALB[(34.98±3.53)g/L 比(30.55±4.07)g/L，t=4.581，P=0.000]HD 组患者高于PD 组患者，而Ca[(2.33±0.18)mmol/L 比(2.53±0.15)mmol/L，t=-4.578，P=0.000]、TC[(5.00±0.81)mmol/L 比(6.36±1.48)mmol/L，t=-4.533，P=0.000]、TG[(1.46±0.37)mmol/L 比(2.30±0.80)mmol/L，t= -5.222，P=0.000]、LDL[(2.78± 0.66)mmol/L 比(3.51±0.81)mmol/L，t=-5.222，P=0.000]、FINS[(6.46±1.86)U/ml 比(8.66±1.42)U/ml，t=- 5.181，P=0.000]、IRI[(0.98±0.30)比(1.34± 0.21)，t= -5.383，P=0.000]HD 组患者低于PD 组患者，组间比较差异有统计学意义。②非糖尿病ESRD 患者存在IR 情况，透析治疗12 月后，PD 组患者IRI 较治疗前升高(1.34±0.21 比1.06±0.21,P＜0.05)，PD 组IRI 较HD 组IRI 升高(1.34±0.21 比0.98±0.30，t=-5.383，P=0.000)，差异有统计学意义。结论非糖尿病ESRD 患者行PD 治疗可能较HD 治疗存在更明显的贫血、蛋白营养不良及糖、脂代谢紊乱等情况，可能更加重患者的IR。对于患者而言，治疗过程中应及早发现并重视患者各种代谢紊乱及IR 情况，早期干预，改善患者预后。

关键词: 透析方式, 终末期肾病, 胰岛素抵抗, 临床指标

Abstract: Objective To compare the effect of hemodialysis (HD) and peritoneal dialysis (PD) on clinical indicators and insulin resistance (IR) in non-diabetic patients with end-stage renal disease (ESRD) in order to provide guidelines for non-diabetic patients with ESRD to select appropriate dialysis modality and to improve the comprehensive treatment. Methods A total of 62 non- diabetic adult (>18 years old) patients with ESRD were enrolled in this study. They hospitalized in our hospital between Sept. 2012 and Feb. 2014, had stable blood pressure (<140/90 mmHg), and were ready for dialysis. They were then divided into HD (n= 32) group and PD group (n=30). Clinical indicators including body mass index (BMI), abdominal circumference (AC), hemoglobin (HGB), hypersensitive c-reactive protein (hsCRP), serum albumin (ALB), urea nitrogen (BUN), serum creatinine (Scr), uric acid (UA), serum calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca×P), intact parathyroid hormone (iPTH), albumin (ALB), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) glycosylated hemoglobin (HbA1C), fasting blood glucose (FBG), true fasting insulin (FINS), and insulin resistance index (IRI) were examined before dialysis and after the dialysis for 6 months and 12 months. The effects of HD and PD on clinical indicators and IR were then assayed. Results ①There were no statistical differences in these clinical indicators between HD and PD groups before dialysis. When clinical indicators after 6 months of dialysis were compared between HD group and PD group, hsCRP (6.91±4.75 mg/L vs. 4.20±3.68 mg/L, t=2.494, P=0.015) and ALB (33.07±2.10 g/L vs. 30.31±3.47 g/L, t=3.851, P= 0.000) were higher in HD group than in PD group; Ca (2.27± 0.15 mmol/L vs. 2.43±0.15 mmol/L, t=-4.150, P=0.000), Ca×P (57.38±7.17 mg2/dl2 vs. 61.49± 7.83 mg2/dl2,  t=-2.159, P=0.035), TC (4.94 ± 0.72 mmol/L vs. 5.50 ± 1.04 mmol/L, t=-2.482, P=0.016), TG (1.52±0.40 mmol/L vs. 1.87±0.72 mmol/L, t=-2.351, P= 0.023),  LDL (2.62±0.54 mmol/L vs. 3.08±0.57 mmol/L, t=-3.294, P= 0.002), and HDL (1.08±0.20 mmol/L vs. 1.29±0.26 mmol/L, t=-3.667, P=0.001) were lower in HD group than in PD group. ②There was no statistical difference in IRI between HD group and PD group (1.16±0.30 vs. 1.06±0.21). After the dialysis for 12 months, IRI increased in PD group (1.34±0.21 vs. 0.98±0.30), and IRI increased more in PD group than in HD group (1.34±0.21 vs. 0.98±0.30). Therefore, PD aggravated IR status. Conclusion In non-diabetic patients with ESRD, anemia, malnutrition, abnormal carbohydrate and lipid metabolism are more common in those after PD than in those after HD. PD may also aggravate IR. Consequently, abnormal metabolism and IR should be emphasized in dialysis period, and corresponding interventionsshould be carried out to improve patients’prognosis.

Key words: Method of dialysis, End-stage renal disease, Insulin resistance, Clinical indicators