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目的分析影响糖尿病肾病腹膜透析患者残余肾功能(residual renal function,RRF)下降的危险因素。方法选取2007—2014年浙江大学附属第一医院肾脏病中心规律持续性不卧床腹膜透析(CAPD)患者880例,其中原发病为糖尿病肾病的患者150例,非糖尿病肾病患者730例。测定其糖化血红蛋白(Hb A_1c)、C反应蛋白(CRP)、血红蛋白(Hb)、白蛋白(ALB)、血尿素氮(BUN)、血肌酐(Scr)、尿肌酐(Ucr)、尿尿素氮(UUN)及24 h尿量等。结果880例患者在规律随访12个月后,糖尿病(DN)组及非糖尿病(非DN)组患者RRF均显著下降,DN组下降较非DN组更快(P<0.05)。DN组中非强化控制血糖组(Hb A_1c>7%)较强化血糖控制组(Hb A_1c<7%)RRF下降速率更快(P<0.05),而强化血糖控制组(Hb A_1c<7%)RRF下降速率与非DN组相近(P>0.05)。DN组中非强化血糖控制组(Hb A_1c≥7%)CRP较非DN组显著增高(P<0.05)。结论原发病为糖尿病的腹膜透析患者强化控制血糖可以更好地延缓RRF下降,而这种效应可能是通过控制腹膜透析患者的微炎症而达到的。
Objective To analyze the risk factors of the decline of residual renal function (RRF) in peritoneal dialysis patients with diabetic nephropathy. Methods A total of 880 CAPD patients from 2007 to 2014 in the First Affiliated Hospital of Zhejiang University were enrolled in this study. Among them, 150 cases were primary diabetic nephropathy and 730 non-diabetic nephropathy. The levels of Hb A 1c, C reactive protein, Hb, ALB, BUN, Scr, Ucr, UUN) and 24 h urine output. Results After 8 months of regular follow-up, 8 months, the RRF of DN group and non-DN group decreased significantly, and DN group decreased more quickly than non-DN group (P <0.05). In DN group, the rate of decline of RRF was higher in intensive glucose control group (Hb A_1c> 7%) than in intensive glucose control group (Hb A_1c <7%) (P <0.05) The decline rate of RRF was similar to that of non-DN group (P> 0.05). CRP in non-intensive glycemic control group (Hb A_1c≥7%) in DN group was significantly higher than that in non-DN group (P <0.05). CONCLUSION: Intensive blood glucose control in peritoneal dialysis patients with primary disease can delay RRF decline better, and this effect may be achieved by controlling microinflammation in peritoneal dialysis patients.