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目的探讨早期低剂量腹膜透析对尿毒症患者残存肾功能的保护及微炎症状态的影响。方法将2008年3月至2011年2月收治的68例慢性肾功能衰竭患者分为两组,其中腹透组34例,接受常规药物治疗,并给予间歇性腹膜透析,每日4000～6000 ml,每周4～5 d;对照组34例,只接受常规药物治疗。所有患者每3个月行残存肾功能测定(RRF)及C-反应蛋白(CRP)检测,研究前后检测肌酐清除率(Ccr)、血钾、血红蛋白,并记录血压和24 h尿量。结果研究结束时,早期低剂量腹膜透析组和对照组的收缩压、舒张压、血红蛋白、血钾水平差异均无统计学意义;腹透组Ccr高于对照组,但对照组较腹透组减少明显(P<0.05)。前6个月两组RRF的明显下降,6个月后腹透组下降变缓,研究结束时腹透组RRF较对照组高(P<0.05)。而从第3个月时腹透组CRP较对照组高(P<0.05)。结论早期使用低剂量腹膜透析可以延缓尿毒症患者残存肾功能的丢失及降低尿毒症患者微炎症状态。
Objective To investigate the effect of early low-dose peritoneal dialysis on renal remodeling and microinflammatory state in patients with uremia. Methods A total of 68 patients with chronic renal failure who were treated from March 2008 to February 2011 were divided into two groups, 34 patients in the PD group received routine drug treatment and were given intermittent peritoneal dialysis daily from 4000 to 6000 ml , 4 ~ 5 days a week; control group, 34 cases, only received conventional drug treatment. Residual renal function tests (RRF) and C-reactive protein (CRP) were performed in all patients every 3 months. Creatinine clearance (Ccr), serum potassium and hemoglobin were measured before and after the study, and blood pressure and 24-hour urine output were recorded. Results At the end of the study, the systolic blood pressure, diastolic blood pressure, hemoglobin and serum potassium levels in the early low-dose PDT and control groups had no significant difference. Ccr in the PD group was higher than that in the control group, but decreased in the control group compared with the PD group Obviously (P <0.05). In the first 6 months, the RRF decreased significantly in both groups. After 6 months, the PD decreased. At the end of the study, RRF in the PD group was higher than that in the control group (P <0.05). However, CRP in the peritoneal dialysis group was higher than that in the control group from the third month (P <0.05). Conclusion Early use of low-dose peritoneal dialysis can delay the loss of residual renal function in patients with uremia and reduce the micro-inflammatory state in patients with uremia.