腹膜透析患者透析時(shí)間、微炎癥及透析充分性與營(yíng)養(yǎng)狀態(tài)的關(guān)系

劉昊虹　劉威　黃麗芳

【摘要】 目的：探討腹膜透析患者透析時(shí)間、微炎癥及透析充分性與營(yíng)養(yǎng)狀態(tài)的關(guān)系。方法：將2015年8月-2017年12月本院腎病科收治的106例持續(xù)性不臥床腹膜透析（CAPD）患者作為研究對(duì)象。根據(jù)患者透析時(shí)間分為透析2年以下組46例、透析2～4年組37例、透析4年以上組23例。選擇同期本院60例健康體檢者臨床資料作為對(duì)照組。比較不同透析時(shí)間患者微炎癥狀態(tài)、透析充分性及營(yíng)養(yǎng)狀態(tài)的差異，分析患者微炎癥及透析充分性與營(yíng)養(yǎng)狀態(tài)關(guān)系。結(jié)果：透析4年以上組、透析2～4年組、透析2年以下組腹膜透析患者CRP、iPTH、β2-MG、MQSGA均高于對(duì)照組，其Kt/V、ALB、MAMC均低于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05），上述指標(biāo)在透析4年以上組、透析2～4年組、透析2年以下組患者，組間兩兩比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；隨著透析時(shí)間的延長(zhǎng)，CRP、iPTH、β2-MG、MQSGA水平越高，Kt/V、ALB、MAMC也越低。CRP及iPTH水平與營(yíng)養(yǎng)狀態(tài)中MAC、MAMC均成負(fù)相關(guān)，與MQSGA成正相關(guān)（P<0.05），與TSF、BSF、HGS無(wú)明顯相關(guān)性；Kt/V、ALB水平與營(yíng)養(yǎng)狀態(tài)中MAC、MAMC均成正相關(guān)，與MQSGA呈負(fù)相關(guān)（P<0.05），與TSF、BSF、HGS無(wú)明顯相關(guān)性。透析時(shí)間、Kt/V、ALB、iPTH、CRP、基礎(chǔ)性疾病是影響腹膜透析患者營(yíng)養(yǎng)狀態(tài)獨(dú)立影響因素。結(jié)論：透析時(shí)間長(zhǎng)、微炎癥及透析不充分是腹膜透析患者營(yíng)養(yǎng)狀態(tài)不佳的重要影響因素，也是其獨(dú)立影響因素，臨床上應(yīng)及早干預(yù)和治療，以提高患者生存質(zhì)量及生存期。

【關(guān)鍵詞】 腹膜透析； 透析時(shí)間； 微炎癥； 透析充分性； 營(yíng)養(yǎng)狀態(tài)

Relationship between Dialysis Time，Micro-inflammation，Dialysis Adequacy and Nutritional Status in Peritoneal Dialysis Patients/LIU Haohong，LIU Wei，HUANG Lifang.//Medical Innovation of China，2018，15（17）：0-018

【Abstract】 Objective：To investigate the relationship between dialysis time，micro-inflammation，dialysis adequacy and nutritional status in peritoneal dialysis patients.Method：106 patients of receiving the continuous ambulatory peritoneal dialysis（CAPD） from August 2015 to December 2017 in our Nephrology Department were selected.The subjects were divided into <2 years group（46 cases），2-4 years group （37 cases） and >4 years group （23 cases） according to the dialysis time.60 health check-ups were selected as control group.The correlation of micro-inflammation and dialysis adequacy with nutritional status was analyzed.Result：The indices of CRP，iPTH， β2-MG and MQSGA for >4 years group，2-4 years group and <2 years group were higher than those in control group（P<0.05）；the indices of Kt/V，ALB and MAMC for >4 years group，2-4 years group and <2 years group were lower than those in control group（P<0.05）；the above indices for >4 years group，2-4 years group and <2 years group were significantly different（P<0.05）；as the dialysis time was extended，the indices of CRP，iPTH，β2-MG and MQSGA were increased while the indices of Kt/V，ALB and MAMC were reduced.The indices of CRP and iPTH were negatively correlated with MAC and MAMC and positively correlated with MQSGA（P<0.05）；the indices of CRP and iPTH had no obvious correlation with TSF，BSF and HGS；the indices of Kt/V and ALB were positively correlated with MAC and MAMC and negatively correlated with MQSGA（P<0.05）；the indices of Kt/V and ALB had no obvious correlation with TSF，BSF and HGS；the independent influence factors of nutritional status included the dialysis time，Kt/V，ALB，iPTH，CRP and basic diseases.Conclusion：The independent influence factors of the poor nutritional status include the long dialysis time，micro-inflammation and dialysis inadequacy，the early intervention and therapy can improve their life quality and survival time.