肠道微生态制剂对老年慢性肾衰竭腹膜透析病人残余肾功能、微炎症及氧化应激的影响

doi:10.3969/j.issn.1003-9198.2021.04.010

摘要/Abstract

摘要： 目的观察老年慢性肾衰竭终末期腹膜透析病人经肠道微生态制剂治疗的效果。方法选取2019年1月至2020年1月期间于我院接受腹膜透析的100例老年慢性肾衰竭终末期病人,采用数字奇偶法分为观察组(奇数)与对照组(偶数),每组各50例。对照组行腹膜透析+常规治疗,观察组接受腹膜透析+常规治疗+肠道微生态制剂治疗,2组均治疗2个月。检测并比较2组治疗前后残余肾功能、微炎症状态(CRP、hs-CRP、IL-6及TNF-α)及氧化应激反应[丙二醛(MDA)、超氧化物歧化酶(SOD)及谷胱甘肽过氧化酶(GSH-Px)]水平;比较治疗期间2组腹膜炎发生率。结果治疗2个月后,2组残余肾功能均较治疗前改善,且观察组改善更显著(P＜0.05);2组CRP、hs-CRP、IL-6、TNF-α、MDA、SOD及GSH-Px水平均较治疗前改善,且观察组改善更显著(P＜0.05);治疗期间观察组腹膜炎发生率显著低于对照组(P＜0.05)。结论老年慢性肾衰竭终末期腹膜透析病人联合使用肠道微生态制剂,有助于改善病人残余肾功能,减轻全身微炎症反应及氧化应激程度,降低腹膜炎发生率,临床应用价值高。

关键词: 慢性肾衰竭, 腹膜透析, 肠道微生态制剂, 残余肾功能, 微炎症, 氧化应激

Abstract: Objective To observe the effect of intestinal microecological preparation in the elderly patients with chronic renal failure at end stage undergoing peritoneal dialysis. Methods A total of 100 elderly patients with chronic renal failure at end stage who underwent peritoneal dialysis in the hospital from January 2019 to January 2020 were selected, and they were divided into observation group and control group according to parity number method, with 50 cases in each group. The control group was treated with peritoneal dialysis and routine treatment, and the observation group was treated with peritoneal dialysis, routine treatment and intestinal microecological preparation. Both groups were treated for 2 months. The residual renal function, micro-inflammation state [C-reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] and oxidative stress response [malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)] of the two groups were detected before treatment and 2 months after treatment; The incidence rate of peritonitis in the two groups was recorded during 2 months of treatment. Results After 2 months of treatment, the residual renal function of both groups was significantly lower than that before treatment, especially in the observation group (P<0. 05); The levels of CRP, hs-CRP, IL-6, TNF-α and MDA in both groups were significanty lower, while the levels of SOD and GSH-Px were significantly higher than those before treatment, especially in the observation group (P<0. 05); During the treatment, the incidence rate of peritonitis in the observation group was lower than that in the control group (P<0. 05). Conclusions The combination of intestinal microecological preparation in treatment of peritoneal dialysis in the elderly patients with chronic renal failure at end stage can improve the residual renal function, alleviate the degree of systemic micro-inflammatory response and oxidative stress, and decrease the incidence rate of peritonitis, which has a high clinical application value.

Key words: chronic renal failure, peritoneal dialysis, intestinal microecological preparation, residual renal function, micro-inflammation, oxidative stress

中图分类号:

R 692.5

刘翠兰, 金玉杰, 韩小丽, 刘圣君, 郭宝珠, 刘俊芬. 肠道微生态制剂对老年慢性肾衰竭腹膜透析病人残余肾功能、微炎症及氧化应激的影响[J]. 实用老年医学, 2021, 35(4): 358-361.

LIU Cui-lan, JIN Yu-jie, HAN Xiao-li, LIU Sheng-jun, GUO Bao-zhu, LIU Jun-fen. Effect of intestinal microecological preparation on residual renal function, micro-inflammation and oxidative stress in elderly patients with chronic renal failure undergoing peritoneal dialysis[J]. Practical Geriatrics, 2021, 35(4): 358-361.

参考文献

[1] ETTA P K, SHARMA R K, GUPTA A. Study of chronic kidney disease-mineral bone disorders in newly detected advanced renal failure patients: a hospital-based cross-sectional study[J]. Saudi J Kidney Dis Transpl, 2017, 28(4):874-885.
[2] WAKEEL J S A, GHONAIM M A, ALDOHAYAN A, et al. Appraising the outcome and complications of peritoneal dialysis patients in self-care peritoneal dialysis and assisted peritoneal dialysis: a 5-year review of a single Saudi center[J]. Saudi J Kidney Dis Transpl, 2018, 29(1):71-80.
[3] SALZER W L. Peritoneal dialysis-related peritonitis: challenges and solutions[J]. Int J Nephrol Renovasc Dis, 2018, 11(11):173-186.
[4] 刘欣欣, 冯爱平. 肠道微生态与肾脏疾病的相关性研究进展[J]. 临床肾脏病杂志, 2018, 18(2):68-71.
[5] MEIJERS B, JOURET F, EVENEPOEL P. Linking gut microbiota to cardiovascular disease and hypertension: Lessons from chronic kidney disease[J]. Pharmacol Res, 2018, 133(23):101-107.
[6] 邓桃枝, 韩向阳, 张洁, 等. 微生态制剂对慢性肝衰竭病人肠道微生态、免疫功能及炎症反应的影响[J]. 中国病原生物学杂志, 2018, 13(4):408-412.
[7] 中国中西医结合学会肾脏疾病专业委员会. 慢性肾衰竭中西医结合诊疗指南[J]. 中国中西医结合杂志, 2015, 35(9):1029-1033.
[8] LI P K, SZETO C C, PIRAINO B, et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment[J]. Perit Dial Int, 2016, 36(5):481-508.
[9] PECOITS-FILHO R, YABUMOTO F M, CAMPOS L G, et al. Peritonitis as a risk factor for long-term cardiovascular mortality in peritoneal dialysis patients: the case of a friendly fire?[J]. Nephrology, 2018, 23(3):253-258.
[10] SHANMUGANATHAN M, GOH B L, LIM C T S. Streptococcus gallolyticus subsp. pasteurianus peritonitis in a patient on continuous ambulatory peritoneal dialysis[J]. Indian J Nephrol, 2017, 27(6):488-495.
[11] 熊任芝, 吴清明, 龙辉. 肠道菌群与肝硬化自发性细菌性腹膜炎关系的研究进展[J]. 临床消化病杂志, 2019, 31(3):190-194.
[12] 刘慧敏, 韩怡, 陆习婷. 益生菌联合抗幽门螺杆菌治疗老年胃溃疡病人的临床疗效及对胃功能和肠道菌群的影响[J]. 实用老年医学, 2020, 34(2):121-124.
[13] SCARPATO E, RUSSO M, STAIANO A, et al. Probiotics in pediatric gastroenterology: emerging indications inflammatory bowel diseases[J]. J Clin Gastroenterol, 2018. DOI: 10.1097/MCG.0000000000001095.
[14] JAZAYERI S, KHOSRAVI-DARANI K, SOLATI Z, et al. Effects of probiotics on biomarkers of oxidative stress and inflammatory factors in petrochemical workers: A Randomized, Double-blind, Placebo-controlled Trial[J]. Int J Prev Med, 2015, 6(1):82-87.
[15] GONG Z Y, YUAN Z Q, DONG Z W, et al. Glutamine with probiotics attenuates intestinal inflammation and oxidative stress in a rat burn injury model through altered iNOS gene aberrant methylation[J]. Am J Transl Res, 2017, 9(5):2535-2547.