本文選題：慢性腎功能衰竭 + 血液透析　； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：研究慢性腎功能衰竭患者血清葉酸水平及其相關(guān)因素分析，了解血液透析、腹膜透析對維持性透析患者血清葉酸水平的影響。 方法：選取2013年9月-2014年3月在大連醫(yī)科大學(xué)附屬第二醫(yī)院住院患者59例，均診斷為慢性腎功能不全尿毒癥期CKD5期。其中血液凈化中心維持性血液透析（HD）患者23例，持續(xù)非臥床腹膜透析（CAPD）患者16例，暫未行透析治療患者20例，健康體檢人員25例。分組方式：1）將住院明確診斷為慢性腎衰竭尿毒癥期患者59例作為尿毒癥組，健康體檢人員25例作為正常對照組，通過觀察59名慢性腎功能衰竭患者葉酸水平估計(jì)整體慢性腎功能衰竭患者葉酸水平。2）根據(jù)透析與否、透析方式將慢性腎衰竭患者分為血透組、腹透組、未透組，健康體檢人員25例作為正常對照組，比較各組別血清葉酸水平。3）血液透析患者按透析前、透析后分為透前組、透后組，研究血液透析對于血清葉酸清除情況。 結(jié)果：59名慢性腎功能衰竭患者血清葉酸水平：9.21±4.5ng/ml，維生素B12水平650±229pg/ml。其中血清葉酸水平低于正常值共12例，占總數(shù)20.3%，正常水平46例，占78.0%，高于正常水平1例，占1.7%。血透組患者葉酸水平低于正常6例，占血透患者26.1%，正常水平16例，占69.7%,高于正常水平1例，占4.2%。其中腹透組患者葉酸水平低于正常5例，占腹透患者31.2%，正常水平11例，占68.8%，高于正常水平0例。未透組患者葉酸水平低于正常1例，占5%，正常水平19例，占95%，高于正常水平0例，占0%。其中正常對照組葉酸水平低于正常0例，正常水平24例，占96%，高于正常水平1例，占4%。血透組患者血清葉酸水平9.3±4.1ng/ml，腹透組8.55±4.3ng/ml，未透組9.5±4.2ng/ml，正常對照組11.1±4.3ng/ml，尿毒癥患者血清葉酸水平低于正常對照組，有顯著性差異（p0.05），血透組、腹透組葉酸水平明顯低于正常對照組，有顯著性差異（p0.05）。未透析組患者血清葉酸水平低于正常對照組，，無顯著性差異（p0.05）,腹膜透析組葉酸水平低于血液透析組葉酸水平，但無顯著性差異（p0.05）.血液透析患者透析前與透析后葉酸水平有顯著差異（p0.05）。尿毒癥患者血清葉酸水平與維生素B12水平呈正相關(guān)（p0.05），與血紅蛋白、平均紅細(xì)胞體積、血清鐵、鐵蛋白、尿毒氮、血肌酐、白蛋白水平無相關(guān)性。尿毒癥患者中低葉酸血癥患者平均血紅蛋白80.7±9.7g/l，血清葉酸水平正常的尿毒癥者平均血紅蛋白含量為95.1±11.6g/l，二者有顯著性差異（p0.05）。 結(jié)論：慢性腎功能衰竭患者血清葉酸平均水平低于正常人群血清葉酸水平，血液透析、腹膜透析患者血清葉酸水平均低于正常人群。腹膜透析與血液透析患者血清葉酸水平無明顯差異。血液透析可以清除透析患者血液中部分葉酸。慢性腎功能衰竭患者葉酸水平與維生素B12水平正相關(guān)，葉酸缺乏能夠加重慢性腎功能衰竭患者貧血程度。
[Abstract]:Objective: to study the serum folic acid level and its related factors in patients with chronic renal failure (CRF). Effect of peritoneal dialysis on serum folic acid levels in patients with maintenance dialysis methods: 59 hospitalized patients in the second affiliated Hospital of Dalian Medical University from September 2013 to March 2014 were all diagnosed as chronic renal insufficiency stage CKD5. Among them, 23 patients with maintenance hemodialysis (HD), 16 patients with continuous ambulatory peritoneal dialysis (CAPDD), 20 patients who were not undergoing dialysis treatment and 25 healthy persons. (1) 59 cases of uremic patients who were definitely diagnosed as chronic renal failure (CRF) were treated as uremia group, and 25 healthy persons as normal control group. By observing the folic acid level of 59 patients with chronic renal failure (CRF), the patients with CRF were divided into three groups: hemodialysis group, abdominal dialysis group, incomplete dialysis group. 25 healthy persons were used as normal control group. The serum folic acid levels of each group were compared. The patients were divided into pre-dialysis group, post-dialysis group, pre-dialysis group and post-dialysis group. Results the serum folic acid level was 9. 21 鹵4. 5 ng / ml and vitamin B12 level was 650 鹵229 PG / ml in 59 patients with chronic renal failure. The serum folic acid level was lower than normal in 12 cases (20.3%) and normal level in 46 cases (78.0%), which was higher than normal level in 1 case (1.7%). In the hemodialysis group, folic acid level was lower than normal in 6 cases, accounting for 26.1in hemodialysis patients, normal level in 16 cases (69.7%), and higher than normal level in 1 case (4.2%). In the peritoneal dialysis group, folic acid level was lower than normal in 5 cases, accounting for 31.2%, normal level was 11 cases (68.8%), and above normal level was 0 cases. The level of folic acid was lower than normal in 1 case (5 cases), normal in 19 cases (95%), higher than normal level in 0 cases (0%). In the normal control group, folic acid level was lower than 0 cases, normal level was 24 cases (96%), higher than normal level in 1 case (4%). The serum folic acid level was 9.3 鹵4.1 ng / ml in hemodialysis group, 8.55 鹵4.3 ng / ml in peritoneal dialysis group, 9.5 鹵4.2 ng / ml in underpenetration group and 11.1 鹵4.3 ng / ml in normal control group. The serum folic acid level in uremic patients was significantly lower than that in normal control group (P 0.05). The folic acid level in hemodialysis group and peritoneal dialysis group was significantly lower than that in normal control group. There was significant difference (P 0.05). The level of folic acid in the patients with peritoneal dialysis was lower than that in the hemodialysis group, but there was no significant difference between the two groups (p 0.05). The serum folic acid level in the patients without dialysis was lower than that in the normal control group (p 0.05), but the level of folic acid in peritoneal dialysis group was lower than that in hemodialysis group. The level of folic acid in hemodialysis patients was significantly different from that before and after dialysis (p 0.05). There was a positive correlation between serum folic acid level and vitamin B12 level, but no correlation with hemoglobin, mean erythrocyte volume, serum iron, ferritin, urinary toxic nitrogen, serum creatinine and albumin levels. The mean hemoglobin of patients with low and middle folic acidemia was 80.7 鹵9.7 g / l, and that of uremia patients with normal serum folic acid level was 95.1 鹵11.6 g / l, there was significant difference between them (p 0.05). Conclusion: the mean serum folic acid level in patients with chronic renal failure is 95.1 鹵11.6g / l. Conclusion: the mean serum folic acid level in patients with chronic renal failure is higher than that in patients with chronic renal failure. The level of serum folic acid was lower than that of normal population. The serum folic acid levels in hemodialysis and peritoneal dialysis patients were lower than those in normal subjects. There was no significant difference in serum folic acid levels between peritoneal dialysis patients and hemodialysis patients. Hemodialysis can remove part of folic acid in the blood of dialysis patients. Folic acid levels were positively correlated with vitamin B12 levels in patients with chronic renal failure, and folic acid deficiency aggravated anemia in patients with chronic renal failure.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692.5

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