中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (04): 214-218.doi: 10.3969/j.issn.1671-4091.2016.04.007

• 临床研究 • 上一篇    下一篇

腹膜透析患者血尿酸水平与透析充分性及营养状况的关系研究

刘艳,李晓,任红,黄晓敏,刘思梦,陈楠   

  1. 上海交通大学医学院附属瑞金医院肾脏科
  • 收稿日期:2015-10-27 修回日期:2016-01-28 出版日期:2016-04-12 发布日期:2016-04-19
  • 通讯作者: 李晓 lixiao-rj@163.com E-mail:lixiao-rj@163.com
  • 基金资助:

    国家自然科学基金(81170671)

The association of serum uric acid level with dialysis adequacy and nutritional status in peritoneal dialysis patients

  • Received:2015-10-27 Revised:2016-01-28 Online:2016-04-12 Published:2016-04-19

RichHTML

0

PDF

280

摘要： 目的初步探讨维持性腹膜透析患者血尿酸(serum uric acid,SUA)水平与透析充分性及营养状况之间的关系。方法选取2008 年1 月～2014 年7 月上海交通大学医学院附属瑞金医院肾脏科开始维持性腹膜透析(peritoneal dialysis,PD)并规律随访12 个月以上的患者共266 例。根据基线SUA水平分为高尿酸血症组和正常血尿酸组,分析两组患者SUA 水平与营养状况指标血清前白蛋白、总蛋白、白蛋白、标准蛋白分解率、尿素氮等及透析充分性指标周尿素清除指数和周肌酐清除率、残余肾功能等的关系。结果基线时高尿酸血症组与正常血尿酸组相比，前白蛋白[(367.076±75.734)mg/L 比(344.644±72.750)mg/L,t=2.428,P=0.016]、总蛋白[(62.713± 8.223)g/L 比(59.807±6.916)g/L,t=3.058,P=0.002]、白蛋白[(33.671 ± 4.307)g/L 比(31.025 ± 4.812)g/L,t=4.678,P＜0.001]、血肌酐[(728.096 ± 271.527)μmol/L 比(647.550 ± 242.555)μmol/L,t=2.525,P=0.012]、尿素氮[18.000(14.300,22.450)mmol/L 比14.850(12.150,18.200)mmol/L,Z=- 4.205,P＜0.001]、三酰甘油[1.805(1.285,2.537)mmol/L 比1.475(1.129,2.382)mmol/L,Z=- 2.241,P=0.025]、血磷[1.545(1.288,1.803)mmol/L 比1.335(1.130,1.530)mmol/L,Z =-4.519,P＜0.001]较高，差异有统计学意义。透析12 个月时患者SUA 水平显著下降[(410.335 ± 86.769)μmol/L 比(387.966 ± 79.638)μmol/L,t=4.640,P＜0.001]，多元回归分析显示SUA 水平与男性(β=28.473,P=0.011)、体质量指数(β=3.903,P =0.015)、收缩压(β=0.882,P =0.010)、白蛋白(β=3.205,P =0.013)、血磷(β=42.248,P= 0.005)呈正相关，与年龄(β=-0.966,P=0.011)、糖尿病史(β=-25.427,P =0.047)、尿素清除指数(β=-21.214,P =0.019)呈负相关。Logistic 回归分析显示男性(OR 8.354，95% CI 2.854～24.465，P＜0.001)、糖尿病病史(OR7.258，95% CI 1.741～30.268，P =0.007)、高尿酸血症(OR 3.368，95% CI 1.181～9.602，P=0.023)、体质量指数升高(OR 1.481，95% CI 1.244～1.762，P＜0.001)、血红蛋白下降(OR 0.971，95% CI 0.947～0.996，P=0.025)及残余肾功能下降(OR 0.275，95% CI 0.178～0.425，P＜0.001)与腹膜透析不充分显著相关。结论PD 可有效改善高尿酸血症，SUA 水平与透析充分性及营养状态密切相关，较高的SUA 表明PD
患者营养状态较好，同时高尿酸血症又与透析不充分有关。

关键词: 腹膜透析, 血尿酸, 透析充分性, 营养状况

Abstract: Objective To investigate the association of serum uric acid (SUA) level with dialysis adequacy and nutritional status in peritoneal dialysis (PD) patients. Methods This was a retrospective study involving 266 subjects who started PD in our center from January 2008 to July 2014 and were followed up for more than 12 months. Patients were divided into hyperuricemia group and normal SUA group based on SUA level. The association of SUA with nutritional status including prealbumin, total protein, albumin, normalized protein catabolic rate, blood urea nitrogen and with PD adequacy indices including Kt/V, total creatinine clearance
(Ccr) and residual renal function (RRF) were analyzed. Results As compared with normal SUA group at baseline, patients in hyperuricemia group at baseline had higher prealbumin (367.076±75.734 vs. 344.644± 72.750 mg/L, t=2.428, P=0.016), total protein (62.713±8.223 vs. 59.807±6.916 g/L, t=3.058, P=0.002), albumin (33.671 ± 4.307 vs. 31.025 ± 4.812 g/L, t=4.678, P＜0.001), serum creatinine (728.096 ± 271.527 vs.647.550 ± 242.555 μmol/L, t=2.525, P=0.012), blood urea nitrogen [18.000 (14.300, 22.450) vs. 14.850 (12.150, 18.200) mmol/L, Z=- 4.205, P＜0.001], triglyceride [1.805 (1.285, 2.537) vs. 1.475 (1.129, 2.382) mmol/L, Z=- 2.241, P=0.025] and phosphorus [1.545 (1.288, 1.803) vs. 1.335 (1.130, 1.530) mmol/L, Z=- 4.519, P＜0.001]. After PD for 12 months, SUA decreased obviously (410.335±86.769 vs. 387.966±79.638 μmol/L, t=4.640, P＜0.001). Multiple regression analyses showed that SUA was positively correlated with male gender (β=28.473, P=0.011), body mass index (β=3.903, P=0.015), systolic blood pressure (β=0.882, P= 0.010), albumin level (β=3.205, P=0.013), and phosphorus level (β=42.248, P=0.005), and negatively correlated with age (β=-0.966, P=0.011), history of diabetes mellitus (β=-25.427, P=0.047), and Kt/V (β=-21.214, P= 0.019). Logistic regression analyses indicated that male, history of diabetes, hyperuricemia, higher body mass index, lower hemoglobin, and lower RRF were significantly correlated with inadequate dialysis. Conclusions PD can effectively improve hyperuricemia. SUA level was closely correlated with nutritional status and dialysis adequacy. Higher SUA in PD patients may suggest the relatively good nutritional status, but hyperuricemia may also associate with inadequate dialysis.

Key words: peritoneal dialysis, serum uric acid, dialysis adequacy, nutritional status