腹膜透析导致的蛋白质丢失及其影响因素分析

摘要

Objective To investigate the components of protein in peritoneal dialysate and explore the risk factors causing the protein losses in the peritoneal dialysis patients in Donghua hospital.Methods 122 uremic patients (79 males and 43 females) undergoing continuous ambulatory peritoneal dialysis (CAPD) were enrolled and assigned into high protein losses group (HP) and low protein losses group (LP) according the median losses of protein in dialysate from March 1,2015 to Feb.28,2016.The amount and component of the protein in dialysate were accessed by the immunoturbidimetry and electrophoresis,and the demographic data and clinical data were collected to analyze the difference between the two groups.The logistic regression was applied to disclose the risk factors of the protein losses via dialysate.Results The median of protein losses in CAPD dialysis patients was 4.18 g/24 h,the major component was albumin (0.36 g/L),the other components were transferrin,IgG and IgA,and all of them were more eliminated in the dialysate of patients in HP group (P＜0.001).Furthermore,the patients in HP group showed lower serum albumin (37.33 ± 3.85 vs.39.05 ± 3.88 g/L,P ＜0.001) and higher rate with high transport status (59.0％ vs.34.4％,P=0.006),and high peritoneal transport was risk factors of high protein losses by dialysate (OR 3.08,95％ CI 1.41-6.75).Conclusions CAPD patients may lose substantial amount of protein by dialysis solution,the major components was albumin,and high peritoneal transport was risk factors of high protein losses by dialysate.%目的 分析中山大学附属东华医院腹膜透析患者经腹透液丢失的蛋白质的总量及各种主要蛋白的浓度、成分,并进一步分析造成蛋白质丢失过多的危险因素.方法 选择2015年3月至2016年2月于中山大学附属东华医院行腹膜透析的尿毒症患者122例(男79例,女43例),用免疫比浊法测定腹透液蛋白质总量,用电泳法分析各种蛋白的成分;根据24 h且腹透液蛋白的中位数将患者分为高蛋白丢失组及低蛋白丢失组,比较2组患者一般资料、腹膜转运类型、营养指标及其他临床特征的差别,使用多因素Logistic回归分析造成腹透液蛋白丢失过多的因素.结果 24 h腹透液蛋白中位数为4.18 g,以白蛋白为主(透出液浓度均数:0.36 g/L),其他主要包括转铁蛋白、IgG及IgA;高蛋白丢失组腹透液各种蛋白成分均较低蛋白丢失组高,高蛋白丢失组血清白蛋白水平更低[(37.33±3.85) g/Lvs(39.05±3.88) g/L,P＜0.001];且高蛋白丢失组患者高平均转运及高转运患者比例更高(59.0％vs34.4％,P＜0.05),多因素Logistic回归分析发现腹膜高转运状态(包括高转运及高平均转运)是腹透患者腹透液过多丢失蛋白独立危险因素(OR 3.08,95％ CI 1.41～6.75).结论 经腹膜透析丢失的蛋白质以白蛋白为主,腹膜高转运状态是腹透患者经腹透液丢失过多蛋白的独立危险因素.对于腹膜高转运的腹膜透析患者,应加强营养支持.