影响腹膜透析患者血清缺血修饰白蛋白水平的因素

摘要

Objective:To evaluate the impact factor of ischemia modified albumin ( IMA) in patients on peritoneal dialysis. Methodology:A total of one hundred fifty eight patients on peritoneal dialysis over 3 months, who were 82 males and 76 females with the average ages of 46�1±11�8 years old, were enrolled in this study. Baseline characteristics, IMA levels and other laboratory measurements were collected and analyzed. According to IMA level, the patients were divided into high IMA group (IMA≥85�56 KU/L, n=52) and normal IMA group (IMA<85�56 KU/L, n=106). Results:In high IMA group, the levels of serum albumin, residual renal function and total creatinine clearance rate were significantly lower than those in normal IMA group. Multivariable logistic regression analysis results showed that levels of serum albumin and total creatinine clearance rate were impact factors for IMA. Subgroup analysis was also carried out. IMA and major adverse cardiovascular events in the subgroups of serum albumin<30 g/L were significantly higher than in the other three subgroups. The patients in the subgroup of total creatinine clearance rate<60 L/( W·1�73m2 ) , had significantly higher level of IMA and MACE. Conclusion:The levels of serum albumin and total creatinine clearance were the important factors influencing the IMA in PD patients. Improve nutritional status, protection of residual renal function, increasing peritoneal dialysis adequacy could be very important to reduce the happening of cardiovascular events.%目的：探讨腹膜透析（PD）患者缺血修饰白蛋白（IMA）水平的影响因素。方法：收集终末期肾病行PD治疗超过3个月的患者的基础资料、IMA及各项实验室指标，并对相关指标进行分析。结果：共158例患者进入研究，男性82例，女性76例，平均年龄（46�12±11�81）岁。依据 IMA 水平分为高 IMA 组（52例， IMA≥85�56 KU／L），正常IMA组106例。高IMA组患者血清白蛋白（ Alb）水平、残余肾小球滤过率、总肌酐清除率均低于正常IMA组，回归分析显示PD患者低白蛋白血症和低总肌酐清除率是IMA的最重要影响因素。亚组分析显示Alb＜30 g／L的患者IMA水平、心血管事件发生率与其他各组比较均有统计学差异。总肌酐清除率＜60 L／（ W·1�73m2）的PD患者IMA水平较高、心血管事件发生率较多。结论：Alb水平、总肌酐清除率是影响PD患者IMA水平的重要因素，改善PD患者的营养状态、保护残余肾功能、提高透析充分性对减少心血管事件的发生至关重要。