梅小亿,潘莉娟,董剑,赵峻英,杨静,谢铌奇,王杉,欧国平
MEI Xiaoyi,PAN Lijuan,DONG Jian,ZHAO Junying,YANG Jing,XIE Niqi,WANG Shan,OU Guoping

• 1:重庆市大足区人民医院检验科

摘要(Abstract)：

目的:探究血液透析后尿毒症患者血清肌酐(Cr)、尿素氮(BUN)、血电解质阳离子[钾离子(K~+)、钠离子(Na~+)、钙离子(Ca~(2+))、磷离子(P~(3+))]和24 h尿蛋白水平变化的临床意义。方法:选择行血液透析治疗的尿毒症患者80例为研究组再根据透析效果分为治疗有效组和无效组,同期健康体检者80例为对照组,取研究组患者血液透析前后血液、健康体检者体检时血液,比较2组被检者血清Cr、BUN水平,比较血电解质阳离子K~+、Na~+、P~(3+)及24 h尿蛋白,同时比较透析后尿毒症治疗有效组和无效组患者上述血清学指标变化;采用Pearson相关分析研究组患者血清Cr、BUN、血电解质阳离子水平与24 h尿蛋白水平的相关性。结果:治疗前,研究组患者血清Cr、BUN、K~+、Na~+、P~(3+)和24 h尿蛋白定量水平均高于对照组,Ca~(2+)水平低于对照组(P<0.05);治疗后,研究组患者Cr、BUN、K~+、P~(3+)和24 h尿蛋白水平较治疗前有所降低,但仍高于对照组(P<0.05);尿毒症患者血液透析治疗有效组患者血清Cr、BUN、K~+、P~(3+)和24 h尿蛋白水平明显低于无效组(P<0.001);尿毒症患者血清Cr~+(r=0.810 3,P<0.05)、BUN(r=0.752 4,P<0.05)、K~+(r=0.618 2,P<0.05),P~(3+)(r=0.680 3,P<0.05)均与24 h尿蛋白水平呈正相关。结论:血清Cr、BUN、K~+、Na~+、P~(3+)水平可作为反映尿毒症患者血液透析治疗效果的有效评价指标。
Objective: To investigate the clinical significance of changes in levels of serum creatinine(Cr), blood urea nitrogen(BUN), blood electrolyte cations and 24 h urinary protein quantitation(UPQ) in patients with uremia before and after hemodialysis. Methods: 80 patients with uremia in the treament of hemodialysis in the hospital from October 2017 to August 2018 were selected as the research group and 80 normal volunteers as the control group. The changes of serum Cr, BUN and blood electrolyte cation levels were compared between the two groups before and after treatment. The levels of serum Cr, BUN, blood electrolyte cations and 24 h urine protein were compared between patients with different curative effects. Pearson correlation analysis was performed to determine the correlation between serum Cr, BUN and blood electrolyte cation levels and 24 h UPQ in the research group. Results: The levels of serum Cr, BUN, K~+, Na~+, P~(3+) and 24 h UPQ in the research group before treatment were significantly higher than those in the control group, while the Ca~(2+) level was significantly lower than that in the control group(P<0.05). The levels of Cr, BUN, K~+, P~(3+) and 24 h UPQ in the research group decreased after treatment but they were still significantly higher than those in the control group(P<0.05). There was no significant change in the level of Na~+ or Ca~(2+) in the research group before and after treatment(P>0.05). Hemodialysis was markedly effective in 21 cases(26.25%), effective in 45 cases(56.25%) and ineffective in 14 cases(17.50%). The levels of Cr, BUN, K~+ and P~(3+) in the effective group were significantly lower than those in the control group(P<0.05). There was no significant difference in the level of Na~+ or Ca~(2+) between the effective group and the ineffective group(P>0.05). Pearson correlation analysis showed that the levels of serum Cr, BUN, K~+ and P~(3+) in the research group were positively correlated with the 24 h UPQ(P<0.05). Conclusion: Levels of Cr, BUN, K~+, Na~+ and P~(3+) can be used as an effective evaluation index to reflect the therapeutic effect of hemodialysis in patients with uremia.

关键词(KeyWords)： 尿毒症;肾透析;血尿素氮;肌酐;电解质阳离子;24 h尿蛋白
uremia;renal dialysis;creatinine;blood urea nitrogen;electrolyte cation;24 h urine protein quantitation

Abstract:

Keywords:

基金项目(Foundation): 重庆市大足区科学技术基金项目(DZKJ,2019ACC1018)

作者(Author): 梅小亿,潘莉娟,董剑,赵峻英,杨静,谢铌奇,王杉,欧国平
MEI Xiaoyi,PAN Lijuan,DONG Jian,ZHAO Junying,YANG Jing,XIE Niqi,WANG Shan,OU Guoping

DOI: 10.19367/j.cnki.1000-2707.2019.12.022

参考文献(References)：

• [1] 危正南,张庆红,吴东,等.高通量血液透析对尿毒症患者血浆毒素分子含量及机体微炎症状态的影响[J].海南医学院学报,2016,22(6):558-561.
• [2] SU H H,KAO C M,LIN Y C,et al.Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis:a nationwide cohort study[J].Atherosclerosis,2017,265:155-161.
• [3] 段胜东.不同血液透析方法对维持性透析患者尿毒症毒素清除效果及营养状态的影响[J].实用临床医药杂志,2015,19(19):26-29.
• [4] 王茹,张俊录,张志杰,等.血液灌流联合血液透析改善尿毒症慢性并发症的效果观察[J].人民军医,2016,59(4):364-366.
• [5] 刘旭,刁宗礼,刘文虎.慢性肾脏疾病患者血钾控制的研究进展[J].临床和实验医学杂志,2018,17(1):109-111.
• [6] 宋国巍,王磊.现有透析疗法对慢性肾衰竭尿毒症患者微炎症状态的影响[J].中国实验诊断学,2015,19(7):1199-1200.
• [7] 刘晓城.肾脏病诊疗指南[M].科学出版社,2005.
• [8] 康阳阳,刘章锁,刘东伟.中国成人慢性肾脏病患病率荟萃分析[J].中国实用内科杂志,2016,36(9):785-789.
• [9] RODRIGUES V P,FRANCO M M,MARQUES C P,et al.Salivary levels of calcium,phosphorus,potassium,albumin and correlation with serum biomarkers in hemodialysis patients[J].Archives of Oral Biology,2016,62:58-63.
• [10]卢光娅,谭若芸.不同血流量血液灌流联合血液透析治疗尿毒症的临床疗效观察[J].临床和实验医学杂志,2016,15(1):6-8.
• [11]张金林.三种不同血液净化方式的疗效观察[J].中国临床医生杂志,2017,45(1):49-50.
• [12]王天生,王东红,师军华,等.慢性肾脏病患者血液透析前后肾纤维化指标及肾功能的变化研究[J].中国实验诊断学,2016,20(7):1090-1093.
• [13]谷卉,杜晓刚.维持性血液透析尿毒症患者的预后及其危险因素研究进展[J].中国全科医学,2018,20(18):98-103.
• [14]孙嘉康.尿毒清颗粒联合血液透析应用于尿毒症患者对其营养改善及肾功能保护作用研究[J].中国中西医结合肾病杂志,2017,18(12):1105-1107.
• [15]郑磊,姜蕾,梁伟.高、低通量血透对尿毒症维持性血透患者残余肾功能的保护作用[J].海南医学,2016,27(12):1912-1915.
• [16]马婉乐,孙雪,喻婉莹,等.慢性肾疾病和尿毒症毒素对非肾清除影响的研究进展[J].中国临床药理学杂志,2016,32(9):861-864.
• [17]孙豫东,王俐.尿毒症患者内环境平衡失调和对尿毒症性心脏结构和功能的影响[J].中国中西医结合肾病杂志,2016,17(12):1089-1092.
• [18]孙小伟,李倩,WEI S X,等.高通量血液透析联合罗盖全对尿毒症患者钙磷代谢紊乱及微炎症状态的影响[J].海南医学,2016,27(20):3331-3334.
• [19]张俊,王新美,赵霞,等.高通量血液透析对尿毒症患者血清磷及高敏C反应蛋白、白蛋白、前白蛋白、转铁蛋白的影响分析[J].中国地方病防治杂志,2017,32(7):729-729.
• [20]GUBENSEK J,ORSAG A,PONIKVAR R,et al.Calcium mass balance during citrate hemodialysis:a randomized controlled trial comparing normal and low ionized calcium target ranges[J].Plos One,2016,11(12):e0168593.
• [21]高潮清,周加军.血液透析与腹膜透析对尿毒症病人钙磷代谢的影响比较[J].蚌埠医学院学报,2017,42(4):472-473.
• [22]武贵群,张志强,李鑫宇,等.高通量血液透析对钙磷代谢及甲状旁腺激素的影响分析[J].中国中西医结合肾病杂志,2017,18(1):61-63.
• [23]林才雄,黎德葵,符龙星.尿毒症患者不同方案维持性血液透析临床对比研究[J].西北国防医学杂志,2016,37(7):485-486.
• [24]SHARMA M K,WIERINGA F P,FRIJNS A J,et al.On-line monitoring of electrolytes in hemodialysis:on the road towards individualizing treatment[J].Expert Review of Medical Devices,2016,13(10):1-11.
• [25]林正均,罗昭强,金仙勇,等.血液透析的不同模式治疗急性肾功能衰竭患者的有效性及对肾功能、电解质的影响[J].安徽医药,2016,20(2):316-319.

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