Grzegorzewska A E, Mariak I
Department of Nephrology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
Adv Perit Dial. 2001;17:5-9.
The present study looked for variations in blood morphology between diabetic patients (group I, n = 7) and non diabetic patients (group II, n = 16) treated with continuous ambulatory peritoneal dialysis (CAPD). A subsequent trial sought to find a reason for discrepancies in the results between the two groups. The patients in both groups and similar ages, CAPD durations, and erythropoietin dosages. Nutrition, CAPD adequacy, serum iron and ferritin levels, total iron binding capacity (TIBC), transferrin saturation (TSAT), red blood cells (RBCs), mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), hemoglobin (Hb), hematocrit (Hct), white blood cells (WBCs), total lymphocyte count (TLC), platelets (PLTs), and serum intact parathyroid hormone (PTH) were evaluated every three months. The mean result of each parameter was obtained in every patient as representative for the entire CAPD course. Means and standard deviations for all respective parameters were then calculated for the two groups and compared. In patients with diabetes as compared with patients without diabetes, significantly higher numbers of RBCs, WBCs, and PLTs were seen, as were higher values for Hb and Hct and a lower serum PTH concentration. Values for WBCs, PLTs, and MCH obtained in all patients (n = 23) were correlated with serum intact PTH (r = -0.520, p = 0.011; r = -0.422, p = 0.045; and r = -0.436, p = 0.037 respectively). When data obtained in the patients receiving erythropoietin were excluded and the correlation analysis was repeated for the 10 remaining patients, a correlation between serum PTH and RBCs was found (r = -0.685, p = 0.029). With comparable age, renal function, nutrition, erythropoietin dosage, iron indices, and CAPD adequacy, duration, and outcome, higher parameters of blood morphology in diabetic patients may be related to lower levels of serum intact PTH, indicating no or only mild secondary hyperparathyroidism. Patients with diabetes usually show smaller disturbances in PTH level than do non diabetic uremic patients on CAPD. Better peripheral morphology indices in the group with diabetes can be expected when other factors affecting hematologic status are similar.
本研究旨在探寻接受持续性非卧床腹膜透析（CAPD）治疗的糖尿病患者（I组，n = 7）与非糖尿病患者（II组，n = 16）之间血液形态的差异。随后的一项试验试图找出两组结果存在差异的原因。两组患者年龄、CAPD治疗时长及促红细胞生成素剂量相近。每三个月评估一次营养状况、CAPD充分性、血清铁和铁蛋白水平、总铁结合力（TIBC）、转铁蛋白饱和度（TSAT）、红细胞（RBC）、平均红细胞血红蛋白含量（MCH）、平均红细胞体积（MCV）、平均红细胞血红蛋白浓度（MCHC）、血红蛋白（Hb）、血细胞比容（Hct）、白细胞（WBC）、总淋巴细胞计数（TLC）、血小板（PLT）以及血清完整甲状旁腺激素（PTH）。获取每位患者各参数的平均结果，作为整个CAPD疗程的代表。然后计算两组所有相应参数的均值和标准差并进行比较。与非糖尿病患者相比，糖尿病患者的RBC、WBC和PLT数量显著更高，Hb和Hct值也更高，而血清PTH浓度更低。所有患者（n = 23）的WBC、PLT和MCH值与血清完整PTH相关（分别为r = -0.520，p = 0.011；r = -0.422，p = 0.045；r = -0.436，p = 0.037）。排除接受促红细胞生成素治疗患者的数据后，对其余10名患者重复进行相关性分析，发现血清PTH与RBC之间存在相关性（r = -0.685，p = 0.029）。在年龄、肾功能、营养状况、促红细胞生成素剂量、铁指标以及CAPD充分性、治疗时长和结果相当的情况下，糖尿病患者较高的血液形态参数可能与较低的血清完整PTH水平有关，表明无继发性甲状旁腺功能亢进或仅有轻度继发性甲状旁腺功能亢进。与接受CAPD治疗的非糖尿病尿毒症患者相比，糖尿病患者的PTH水平通常波动较小。当影响血液学状态的其他因素相似时，糖尿病组有望获得更好的外周形态学指标。
