發(fā)布時(shí)間：2018-06-12 21:16

  本文選題：腹膜透析 + 血管內(nèi)皮生長因子　； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究背景:腹膜透析是終末期腎臟病的替代治療方法之一,近年來腹膜透析相關(guān)并發(fā)癥也越來越受到重視。腹膜轉(zhuǎn)運(yùn)特性是評(píng)估腹膜透析效能的指標(biāo),影響著PD治療的質(zhì)量及預(yù)后。腹膜血管新生是影響腹膜轉(zhuǎn)運(yùn)功能的機(jī)制之一,可引起腹膜纖維化、腹膜透析超濾衰竭。而血管內(nèi)皮生長因子是血管新生的關(guān)鍵因子,腎素-血管緊張素-醛固酮系統(tǒng)可通過影響VEGF在血管新生的調(diào)節(jié)中起著重要的作用。目的:1、探討影響尿毒癥腹膜透析患者血清VEGF、腹膜透出液VEGF水平的相關(guān)因素,及VEGF介導(dǎo)的血管新生對(duì)腹膜轉(zhuǎn)運(yùn)功能的影響;2、研究腎素-血管緊張素抑制劑對(duì)CAPD患者VEGF水平及腹透蛋白丟失的影響。方法及結(jié)果:一、血管內(nèi)皮生長因子與腹膜轉(zhuǎn)運(yùn)功能相關(guān)性的橫斷面研究:以2016年01月到2017年01月在福州總醫(yī)院規(guī)律隨訪的122例CAPD患者為研究對(duì)象,分別以腹膜平衡實(shí)驗(yàn)(PET)實(shí)驗(yàn)結(jié)果及透析齡進(jìn)行分組,以同期因大量腹水的腎病綜合征患者(10例)作為對(duì)照組,測(cè)定各組患者血清VEGF(sVEGF)、腹膜透出液VEGF(pVEGF)水平及相關(guān)生化檢查結(jié)果,用SPSS軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1、根據(jù)轉(zhuǎn)運(yùn)系數(shù)(D/P Cr)分組比較結(jié)果:(1)不同腹膜轉(zhuǎn)運(yùn)水平的各組CAPD患者sVEGF均較對(duì)照組明顯增高;(2)高轉(zhuǎn)運(yùn)組的sVEGF顯著高于高平均組、低平均組及低轉(zhuǎn)運(yùn)組;(3)對(duì)于pVEGF,高轉(zhuǎn)運(yùn)組水平明顯高于高平均轉(zhuǎn)運(yùn)組、低平均轉(zhuǎn)運(yùn)組、低轉(zhuǎn)運(yùn)組、對(duì)照組,其它3組較對(duì)照組的差異不明顯。2、根據(jù)透析齡分組比較結(jié)果:以1、2年為標(biāo)準(zhǔn)分為長、短期透析組,兩組間的sVEGF、pVEGF水平差異無統(tǒng)計(jì)學(xué)意義;以3年為分界標(biāo)準(zhǔn),長期透析組患者的sVEGF明顯高于短期透析組,pVEGF組間差異不明顯。3、CAPD患者中sVEGF與pVEGF水平呈正相關(guān);多因素回歸分析提示sVEGF水平、空腹血糖、高膽固醇血癥是對(duì)pVEGF水平有影響,其中sVEGF水平的影響作用最大。另外,腹透液葡萄糖濃度是影響CAPD患者sVEGF、pVEGF水平的危險(xiǎn)因素,而ACEI/ARB類藥物的應(yīng)用則是保護(hù)性因素。4、肌酐的腹膜溶質(zhì)轉(zhuǎn)運(yùn)系數(shù)(MTACCr)與sVEGF水平呈正相關(guān),與pVEGF水平無相關(guān)性;多因素回歸分析提示sVEGF水平是影響MTAC Cr的危險(xiǎn)因素。5、腹透蛋白丟失量與sVEGF、MTAC Cr呈正相關(guān),多因素回歸分析提示腹膜轉(zhuǎn)運(yùn)水平是腹透蛋白丟失的危險(xiǎn)因素,ACEI/ARB類藥物是保護(hù)性因素。二、腎素-血管緊張素系統(tǒng)抑制劑對(duì)CAPD患者VEGF水平的影響:收集2016年01月至2017年01月于我院規(guī)律隨訪的CAPD患者34例,根據(jù)是否應(yīng)用ACEI/ARB類藥物分成治療組(n=20),對(duì)照組(n=14),觀察時(shí)間為6個(gè)月,收集患者的一般資料、相關(guān)生化指標(biāo),分別在進(jìn)入治療前及治療6個(gè)月后進(jìn)行臨床評(píng)估,評(píng)估內(nèi)容包括D/P Cr、KT/V、CCr、24h腹透蛋白丟失量等,并分別收集當(dāng)時(shí)的血清及腹透液標(biāo)本,檢測(cè)sVEGF及pVEGF濃度,進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1、納入研究前治療組和對(duì)照組在一般資料之間的差異不具有統(tǒng)計(jì)學(xué)意義。2、在治療前后2組患者在pVEGF及各項(xiàng)臨床指標(biāo)之間的差異無統(tǒng)計(jì)學(xué)意義。3、在基線水平治療組與對(duì)照組的sVEGF水平、腹透蛋白丟失量差異不具有統(tǒng)計(jì)學(xué)意義;6個(gè)月后治療組的sVEGF水平、腹透蛋白丟失量較對(duì)照組顯著降低。結(jié)論:1、腹膜透析液的葡萄糖濃度是影響sVEGF、pVEGF水平的危險(xiǎn)性因素,ACEI/ARB類藥物對(duì)減少sVEGF、pVEGF有保護(hù)作用。sVEGF、血糖、高膽固醇血癥是引起pVEGF水平升高的危險(xiǎn)性因素,其中sVEGF水平對(duì)pVEGF的影響最大,推測(cè)pVEGE水平受循環(huán)系統(tǒng)及腹腔環(huán)境局部影響。2、VEGF水平越高,腹膜轉(zhuǎn)運(yùn)水平越高,兩者具有顯著的相關(guān)性,提示VEGF可促進(jìn)腹膜血管新生及增加腹膜血管的通透性,進(jìn)而增加腹膜溶質(zhì)轉(zhuǎn)運(yùn)水平。3、CAPD患者的血清白蛋白水平與sVEGF、pVEGF負(fù)相關(guān);腹膜轉(zhuǎn)運(yùn)水平及sVEGF與腹透蛋白丟失量正相關(guān),提示VEGF可能通過影響腹膜轉(zhuǎn)運(yùn)功能,介導(dǎo)腹透蛋白流失,引起低蛋白血癥。4、ACEI/ARB類藥物可以抑制CAPD患者VEGF產(chǎn)生,減輕腹膜血管新生及滲透性,減輕CAPD患者腹透蛋白丟失量,從而起到保護(hù)腹膜的作用。
[Abstract]:Background: peritoneal dialysis is one of the alternative therapies for end-stage renal disease. In recent years, peritoneal dialysis related complications are becoming more and more important. Peritoneum transport characteristics are the indicators to evaluate the effectiveness of peritoneal dialysis, affecting the quality and prognosis of PD treatment. Peritoneal angiogenesis is one of the mechanisms affecting the peritoneal transport function, which can cause the abdomen. Membrane fibrosis and peritoneal dialysis ultrafiltration failure. Vascular endothelial growth factor (VEGF) is a key factor in angiogenesis. The renin angiotensin aldosterone system can play an important role in the regulation of VEGF in angiogenesis. Objective: 1, to explore the correlation of serum VEGF, VEGF level of peritoneal dialysis fluid in patients with uremia peritoneal dialysis. The effects of VEGF and VEGF mediated angiogenesis on the peritoneal transport function; 2. Study the effect of renin angiotensin inhibitor on VEGF and peritoneal dialysis in CAPD patients. Methods and results: first, a cross-sectional study of the correlation between vascular endothelial growth factor and peritoneal transport function: from 01 months to 01 months of 2017 2016 in Fuzhou General Hospital 122 CAPD patients were followed up. The results of peritoneal balance test (PET) and the age of dialysis were divided into groups. The patients with nephrotic syndrome (10 cases) with massive ascites were used as the control group. The serum VEGF (sVEGF), the VEGF (pVEGF) level of peritoneum and the results of biochemical examination were measured, and the SPSS software was used. Statistical analysis. Results: 1, according to the results of the transfer coefficient (D/P Cr) group comparison: (1) the sVEGF of all CAPD patients with different peritoneal transport levels was significantly higher than that of the control group; (2) the sVEGF of the high transport group was significantly higher than the high mean group, the low mean group and the low transport group; (3) the level of the high transport group was significantly higher than the high average transport group, and the low mean level was lower than the high mean transport group. The difference of the transport group, the low transport group, the control group and the other 3 groups was not obvious.2. According to the results of the dialysis age group, the difference between the two groups was long, the short-term dialysis group and the two groups were sVEGF, the difference of pVEGF level was not statistically significant; the sVEGF of the 3 years was significantly higher than the short-term dialysis group, and the pVEGF group was significantly higher than the short-term dialysis group. The difference was not obvious in.3, and there was a positive correlation between sVEGF and pVEGF levels in patients with CAPD. Multivariate regression analysis suggested that sVEGF level, fasting blood glucose and hypercholesterolemia had an influence on the level of pVEGF, and the effect of sVEGF level was the greatest. In addition, the concentration of glucose in peritoneal dialysis was a risk factor affecting the sVEGF, pVEGF level of CAPD patients and ACEI/ARB drugs. The application of the substance is the protective factor.4, the peritoneal solute transport coefficient (MTACCr) of creatinine is positively correlated with the level of sVEGF, and is not related to the level of pVEGF. The multifactor regression analysis suggests that the sVEGF level is the risk factor of MTAC Cr,.5, the loss of peritoneal dialysis is positively correlated with sVEGF, MTAC Cr, and the multifactor regression analysis suggests the level of peritoneal transport. A risk factor for loss of peritoneal dialysis (ACEI/ARB) is a protective factor. Two, the effect of renin angiotensin system inhibitor on the level of VEGF in patients with CAPD: 34 cases of CAPD patients who were followed up in our hospital from 01 months to 01 months of 2016, according to whether the use of ACEI/ARB drugs was divided into the treatment group (n=20), and the control group (n=14). The time was 6 months. The general data of the patients were collected and the related biochemical indexes were evaluated before and after 6 months of treatment. The evaluation contents included D/P Cr, KT/V, CCr, 24h peritoneal dialysis loss and so on. The serum and peritoneal fluid samples were collected and the concentrations of sVEGF and pVEGF were detected respectively. Results: 1. There was no statistically significant difference between the pre study treatment group and the control group in the general data. There was no statistically significant difference between the 2 groups of patients before and after the treatment in the 2 groups, and there was no significant difference between the pVEGF and the clinical indicators. The difference in the sVEGF level between the baseline and the control group was not statistically significant; the treatment group was 6 months later. The loss of sVEGF was significantly lower than that in the control group. Conclusion: 1, the glucose concentration in Liquor Dialysisintraperitoneus is a dangerous factor affecting the level of sVEGF and pVEGF. ACEI/ARB has a protective effect on the decrease of sVEGF, pVEGF,.SVEGF, blood glucose and hypercholesterolemia are the risk factors for the increase of pVEGF level, of which sVEGF level is to pV. The effect of EGF is the greatest. It is speculated that the level of pVEGE is partly influenced by the circulation system and the peritoneal environment, the higher the level of the VEGF, the higher the level of peritoneal transport, the higher the correlation between the two. It suggests that VEGF can promote the angiogenesis of peritoneum and increase the permeability of the peritoneal vessels, and then increase the level of.3 in the peritoneal solute transport and the serum albumin level of the CAPD patients. There is a negative correlation with sVEGF, pVEGF, the peritoneal transport level and sVEGF are positively related to the loss of peritoneal dialysis protein, suggesting that VEGF may mediate peritoneal transport function, mediate the loss of peritoneal dialysis, cause low proteinemia.4, and ACEI/ARB drugs can inhibit VEGF production in CAPD patients, reduce the angiogenesis and permeability of the abdominal membrane, and reduce the peritoneal dialysis in CAPD patients. Loss of quantity, which plays a role in protecting the peritoneum.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5

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