非糖尿病腹膜透析患者血清鸢尾素水平变化及其影响因素

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目的 评估腹膜透析对终末期肾病(ESRD)患者血清鸢尾素水平的影响,并寻找其与透析充分性、胰岛素抵抗、营养状况和骨代谢状态的关系.方法 选取2018年6月至2019年12月于郑州大学第一附属医院诊断为ESRD、行腹膜透析置管术并规律随访的腹膜透析患者.患者均无糖尿病.收集患者腹膜透析手术前和接受规律腹膜透析治疗3个月及以上的血清标本、临床资料和生化指标.采用酶联免疫吸附法检测患者血清鸢尾素水平.根据血清鸢尾素水平变化情况分为鸢尾素升高组和鸢尾素降低组.对正态分布资料采用t检验和Pearson相关分析,对非正态分布资料采用秩和检验和Spearman相关分析.采用多重线性逐步回归分析探讨腹膜透析患者血清鸢尾素水平变化的独立影响因素.结果 共纳入46例患者,腹膜透析前血清鸢尾素水平为19.13(16.44,22.83)μg·L-1,规律腹膜透析后血清鸢尾素水平为20.27(17.79,22.86)μg·L-1,差异无统计学意义(P>0.05).其中25例患者规律腹膜透析后血清鸢尾素水平[21.21(20.06,23.83)μg·L-1]较腹膜透析前[17.25(15.64,19.05)μg·L-1]升高(P0.05).多重线性逐步回归分析显示,残肾Kt/V(β=3.903,P=0.036)、血钙变化值(β=-4.492,P=0.047)与规律腹膜透析后血清鸢尾素水平变化值独立相关.结论 非糖尿病ESRD患者腹膜透析后血清鸢尾素水平变化不一,保留的残余肾功能有助于提高血清鸢尾素水平,血清鸢尾素水平可能受腹膜透析患者血钙的影响.
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