【作者】 高学军；

【导师】 刘子栋；

【作者基本信息】 山东大学 ， 泌尿外科， 2005， 硕士

【摘要】 目的 研究慢性肾衰患者两种透析模式对患者自身微炎症状态的影响,探讨微炎症状态与炎症反应相关因素,如贫血、营养不良、心血管疾病等的关系。方法 抽取46例尿毒症血液透析患者和18例腹膜透析患者,20例健康对照组(对照组仅检测C反应蛋白)。该三组近1个月无感染并排除糖尿病、恶性肿瘤、肝功能损害、活动性风湿性疾病且未使用糖皮质激素。三组性别构成、年龄差异无统计学意义。透析前取静脉血检测C反应蛋白(CRP)、血肌酐(Scr)、血清白蛋白(ALB)、血清铁蛋白(SF)、Hb、Lp(a)。CRP作为炎症指标,Scr、ALB、SF、Hb、Lp(a)作为相关营养、贫血、心血管疾病指标。比较血透组和腹透组炎症指标。各组内根据CRP水平分为两组,CRP>10mg/L为A组,CRP<10mg/L为B组,比较A、B两组各相关因素(Scr、ALB、Lp(a)等)。CRP与各相关因素(Scr、ALB、Lp(a)等)之间的相关性。调查透析患者心血管疾病,观察透析患者CRP与心血管疾病的关系。 结果 HD组炎症因子C反应蛋白高于腹透组(P<0.05)。各相关因素的比较:HD组内A组Lp(a)高于B组(P<0.05),有统计学意义;A组Hb、ALB低于B组(P<0.05),有统计学意义;A组Scr低于B组,A组SF高于B组,但无统计学差异(P>0.05)。PD组内A组Lp(a)高于B组(P<0.05),有统计学意义;A组HDL、Hb、ALB低于B组(P<0.05),有统计学意义;A组SF、Scr低于B组,但无统计学差异(P>0.05)。HD组与PD组均显示CRP与ALB、Hb呈负相关,与Lp(a)呈正相关。CRP与Scr、SF无相关性。透析患者(包括血透和腹透)中合并心绞痛、心肌梗塞、慢性心衰的患者共37例(57.8%)。其中仅并发心绞痛、心肌梗塞者更多还原

【Abstract】 Objective To study the influence of the two kinds of dialysis to patients’ microinfection ,and evaluate the factors associated with microinfection. Methods To explore 46 blood hemodialysis patients ,18 peritoneal dialysis patients and 20 normal controls,plasma CRP, Scr, ALB, SF, Hb, Lp(a) are measured before hemodialysis. CRP is figured as infectional index. Scr、ALB、SF、 Hb、 Lp(a) are considered as indexes associated with nutrition,anemia and cardiovascular disease. To compare with the infectional indexes between hemodialysis patients and peritoneal dialysis patients. Hemodialysis patients and peritoneal dialysis patients are divided into A (CRP>10mg/L) and B (CRP<10mg/L) themselves. To compare with the factors (Scr 、 ALB、 Lp(a) et) between A and B.Results HD patients’ infectional indexes are higher than PD patients’,such as CRP (P<0.05) .The comparitions of associated factors:In HD patients ,A’ Lp(a) higher than B’ (P<0.05) ,A’ Hb、 ALB are lower than B’ (P<0.05) ;A’ Scr is lower than B’ (P>0.05), A’ SF is higher than B’ (P>0.05). The comparitions of associated factors:In PD patients ,A’ Lp(a) is higher than B’ (P<0.05) ;A’ Hb、 ALB are lower than B’ (P<0.05 ) ;A’ Scr and SF are lower than B’ (P>0.05).Conclusion HD patients’ infection is more serious than PD’s, and infection is associate with ALB,Hb,and Lp(a).Among dialysis patients , cardiovascular disease patients’ CRP are higher than non-cardiovascular disease patients’.Conclusions Microinfection in hemodialysis is more seriously than it in peritoneal dialysis. Microinfection is associated with ALB,Hb and Lp(a).Among dialysispatients, infection is associated with cardiovascular disease.更多还原