| Objectives:In recent years,with the increased incidence of chronic kidney disease(CKD)and end stage renal disease(ESRD)incidence increased year by year,in spite of hemodialysis,peritoneal dialysis and renal transplantation,prolong the survival time of patients with ESRD,but still significantly increased mortality in dialysis patients[1].ESRD patients often appear a variety of complications,such as water,acid-base balance disorders,calcium and phosphorus metabolism disorders,abnormal lipid metabolism,cardiovascular disease,etc.Many studies have confirmed that hyperphosphatemia in patients with ESRD and severe secondary hyperparathyroidism,can cause cardiovascular complications,such as coronary artery disease,valvular heart disease and arterial calcification,and increased mortality[2][3].Cardiovascular disease is a leading cause of death in dialysis patients.At present,the microinflammatory state has become one of the hot spots in the research field of CKD.It has been pointed out that microinflammation is one of the predictors of cardiovascular disease and mortality in maiutenance hemodialysis(MHD)patients[4].Studies have also pointed out that the continuous ambulatory peritoneal dialysis(CAPD)patients are also microinflammatory state,microinflammation this hand will gradually make the peritoneal fibrosis,peritoneal ultrafiltration failure,on the other hand will increase the risk of cardiovascular events[5].It can be seen that the microinflammatory state in patients with MHD and CAPD may be one of the risk factors for cardiovascular events in dialysis patients,this is the consensus of clinical researchers at home and abroad.But for microinflammation in dialysis patients with ESRD have abnormal blood lipid metabolism of calcium and phosphorus without correlation,there is no clear conclusion.Studty have shown that the level of micro inflammatory factors in patients with CAPD has nothing to do with creatinine,calcium,phosphorus and cholesterol levels[6].Also studies show that MHD in patients with hs-CRP has a significant positive correlation with total cholesterol,triglyceride and low density lipoprotein cholesterol,and there is no significant correlation between high density lipoprotein cholesterol and calcium phosphate[7].In this study,through the correlation analysis of hemodialysis patients with micro inflammatory state and lipid metabolism and metabolism of calcium and phosphorus,for dialysis patients to reduce complications and prolong life,reduce medical costs and actively looking for effective ways and means,and and provide guest theoretical basis for the further research in the future.Methods:1.Case data selection:Selection of the First Affiliated Hospital of Kunming Medical University and the Second Affiliated Hospital of from June 2015 to June 2016,31 cases of CAPD patients to peritoneal dialysis group:PD group,16 cases were male,female 15 cases.Selected with the first affiliated hospital of kumning medical university during the period of 31 patients with MHD for hemodialysis group:HD group,15 cases were male,female 16 cases.An alternate 18 healthy volunteers as control group,10 cases of male,female 8 cases.2.Dialysis methods:(1)Hemodialysis:Hemodialysis patients using Japanese Weigao dialysis machine and dialyzer with sugar free dialysate for bicarbonate dialysis,dialysis membrane area of 1.3～1.7m2,the use of anticoagulants ordinary heparin or low molecular weight heparin,the blood flow rate of 200-250L/min,the dialysis flow is 500 mL/min,potassium ion,calcium ion concentration respectively tendency tendency for 2.0 mmol/L and 1.5 mmol/L.Dialysis 2～3 times per week,3～4 h/times,dehydration from 1.5 kg to 3.5kg.(2)Peritoneal dialysis:Given 1.5%or 2.5%dialysate lactate concentration,solution volume of 2000 ml/times,peritoneal dialysis every day,at least 4 times to replace the dialysate during dialysis,the implementation of 24 h uninterrupted dialysis.3.Clinical blood specimen collectionChemiluminescence immunoassay was used to detect hs-CRP and parathyroid hormone.The serum creatinine,urea nitrogen,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,triglyceride,blood calcium,serum phosphorus and so on were detected by automatic biochemistry analyzer.4.Statistical methods:Statistical methods were used to analyze the observed indexes,and P<0.05 was statistically significant.Results:1.HD group of patients serum calcium compliance rate was 45.2%,the standard rate of PD group of patients was 16.1%HD group of patients with serum calcium,serum calcium compliance rate is higher than the PD group,the difference was statistically significant(P<0.05).PD group of patients with blood phosphorus standard rate(45.2%),parathyroid hormone(51.6%)is higher than the standard rate of blood group HD patients the standard rate of phosphorus(32.3%),and parathyroid hormone compliance rate(32.3%),but the difference was not statistically significant(P>0.05).2.HD group of patients with total cholesterol compliance rate(96.8%),the standard rate of low density lipoprotein cholesterol(93.5%),(80.6%)higher than the standard rate of triglyceride total cholesterol compliance rate of patients in group PD(90.3%),the standard rate of low density lipoprotein cholesterol(90.3%),the standard rate of triglycerides(71%);the standard rate of high density lipoprotein cholesterol(38.7%)is lower than that of high density lipoprotein cholesterol PD patients compliance rate(54.8%),but the differences were not statistically significant(P>0.05).3.Compared with the normal control group,The blood of hs-CRP with HD and PD group of patients increased,the difference was statistically significant(P<0.05),but the HD group and PD group patients blood compared to hs-CRP,the difference was not statistically significant(P>0.05).4.HD group of patients with total cholesterol,serum calcium,phosphorus,parathyroid hormone and calcium phosphorus product increased compared to normal control group,high density lipoprotein cholesterol decreased compared to the normal group,the differences were statistically significant(P<0.05);the triglycerides and low density lipoprotein cholesterol were not statistically significant with normal controls(P>0.05).5.PD patients blood total cholesterol,blood phosphorus,parathyroid hormone and calcium-phosphorus product higher than normal control group,blood calcium down,compared with normal control group were statistically significant difference(P<0.05);high-density lipoprotein cholesterol,triglycerides and LDL cholesterol,there was no obvious difference compared with normal controls statistical significance(P>0.05).6.There was no significant difference in total cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,serum calcium,serum phosphorus,calcium phosphorus product,parathyroid hormone in HD group and PD group(P>0.05).7.PD group of patients with triglycerides and hs-CRP have positive correlation(r=0.36,P<0.05),the blood lipid and calcium and phosphorus metabolism index and hs-CRP were not significantly correlated(P>0.05);HD group of patients with blood lipid metabolism and calcium phosphorus metabolism and hs-CRP were not significantly correlated(P>0.05).Conclusions:Long term dialysis patients with microinflammatory state,accompanied by dyslipidemia and abnormal metabolism of calcium and phosphorus at the same time,but the inflammatory state was not significant correlation between serum lipid and calcium phosphorus metabolism of dialysis patients with. |
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