中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (10): 531-535.doi: 10.3969/j.issn.1671-4091.2016.10.005

• 临床研究 • 上一篇    下一篇

超纯透析液对糖尿病血液透析患者的影响

郭东花1,李红梅1,吴华2   

  1. 1北京市监狱管理局中心医院血液透析室  2 北京医院肾内科
  • 收稿日期:2016-05-13 修回日期:2016-08-08 出版日期:2016-10-12 发布日期:2016-10-10
  • 通讯作者: 吴华 wuhua@medmail.com.cn E-mail:guodong111885@sohu.com

The influence of ultrapure dialysate on several main indicators in maintenance hemodialysis patients

  • Received:2016-05-13 Revised:2016-08-08 Online:2016-10-12 Published:2016-10-10

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摘要： 目的探讨超纯透析液对维持性血液透析(maintenance hemodialysis，MHD)糖尿病患者的影响。方法将50 例透析龄超过1 年的MHD 患者根据是否合并糖尿病分为2 组(肾炎组，糖尿病肾病组)，进行为期6 个月的随访，主要监测使用超纯透析液6 个月后患者的微生物指标，营养相关指标，炎症指标，包括透析液微生物学质量、β2-微球蛋白(β2-microglobulin，β2-MG)、血生化指标、C-反应蛋白(C-reactive protein，CRP)、透析充分性和蛋白分解代谢率(protein catabolic rate，PCR)等。结果本研究共入选肾炎组25 例，糖尿病肾病组25 例，改用超纯透析液6 个月后，细菌和内毒素水平明显改善(t=3.465，P=0.000)；患者的血红蛋白(hemoglobin, Hb)、白蛋白(albumin，Alb)明显升高(t=- 1.275，P=0.001)；PCR 水平有所增加(t=-3.332，P=0.000)，但是透析充分性无明显变化(t=0.155，P= 0.879)；CRP 水平变化无统计学意义(t=0.022，P=0.881)，β2-MG 水平降低(t=3.574，P=0.001)。肾炎组改进后的CRP 水平明显低于糖尿病肾病组(t=-1.757，P=0.000)，但其他各项指标在两组中无明显变化(P＞0.05)。多因素分析发现，糖尿病(OR=1.566，95% CI：1.086～2.257，P=0.016)、干体质量(OR=1.007，95% CI：1.002～1.013，P=0.009)与CRP 变化有关。结论改用超纯透析液后，透析液的微生物学质量提高，肾炎及糖尿病肾病患者的营养状态改善，而且肾炎患者的炎症状态改善更加明显。

关键词: 血液透析, 超纯透析液, 糖尿病肾病, 重要指标

Abstract: Purpose To evaluate the effects of ultrapure dialysate on several main indicators in patients with maintenance hemodialysis (MHD). Methods Fifty patients (25 in nephritis group and 25 in diabetic nephropathy group) treated with MHD for more than one year were followed-up for six months for the monitoring of microbial indices, nutrition related indices, inflammatory indices, microbial quality of the dialysate, β2-microglobulin (β2-MG), blood biochemical indices, C-reactive protein (CRP), dialysis adequacy, and protein catabolic rate (PCR) after using ultrapure dialysate for six months. Results After using ultrapure dialysate for six months, bacterial and endotoxin levels improved (t=3.465, P=0.000), hemoglobin (Hb) and albumin (Alb) increased (t=-1.275, P=0.001), PCR increased (t=-3.332, P=0.000), and β2-MG decreased (t=3.574, P=0.001), while dialysis adequacy (t=0.155, P=0.879) and CRP (t=0.022, P=0.881) showed no significant changes.
After using ultrapure dialysate, CRP in nephritis group was significantly lower than that in diabetic nephropathy group (t=-1.757, P=0.000), but other indices had no significant differences between the two groups (P＞0.05). Multivariate analysis revealed that diabetes (OR=1.566, 95% CI 1.086～2.257, P=0.016) and dry
body weight (OR=1.007, 95% CI 1.002～1.013, P=0.009) were related to the change of CRP. Conclusions After using the high quality of ultrapure dialysate, the microbial parameters in the dialysate increased, nutritional status improved in MHD patient with nephritis and diabetic nephropathy, and the improvement of inflammation status was more significant in MHD patient with nephritis.

Key words: Hemodialysis, ultrapure dialysate, diabetic nephropathy, main indicators