| Objectives:To analyses the correlation between serum serum direct bilirubin and nutritional parameters, blood pressure; To analyses the correlation between serum direct bilirubin and NO, identify the clinical significance of serum direct bilirubin in malnutrition and hypertension of CAPD patients.Methods:Cross-sectionally recruited106CAPD patients(dialysis time≧3months) in the Third Xiangya Hospital Nephrology department from October2011to February2014.106healthy people matched with age and sex are recruited from Health Management Center at the same time. The peritoneal dialysis patients were grouped into high serum direct bilirubin group and low serum direct bilirubin group by the median serum direct bilirubin concentration(2.0ummol/L). Collecting demographic and clinical data, Modified Quantitative Subjective global nutritional assessment of nutrition (MQSGA) and laboratory parameters (hemoglobin, serum albumin, triglycerides, total cholesterol, triglycerides, HDL, LDL, glucose, creatinine, urea, uric acid, serum ferritin and transferrin) of these patients. Detecting nitric oxide by the way of nitrite reduction method. The data is analyzed by SPSS17.0. T test, chi-square test, non-parametric Wilcox-on test are used to compare General information, ambulatory blood pressure data, nutrition indicators between the two groups; Linear regression analysis is used to analysis the correlation between serum direct bilirubin and nutritional status, blood pressure, adjusting the confounders at the same time. Risk factors of malnutrition are selected by binary Logistic regression. the correlation between serum direct bilirubin and NO is analyzed by Spearman correlation.Results:(1) The serum direct bilirubin of peritoneal dialysis patients is higher than healthy people. Blood pressure of healthy control group is lower and nutritional status is better than the peritoneal dialysis group(p≦0.018);(3) The systolic blood pressure is lower, serum direct bilirubin group is higher than the high serum direct bilirubin group. It showed statistically significance after adjusting the number of antihypertensive drugs (p=0.007), The diastolic blood pressure, blood pressure variability, nighttime blood pressure decrease rate and morning blood pressure surge in the two groups show no significant difference; nutrition indicators MQSGA and cholesterol in low serum direct bilirubin group is higher than high serum direct bilirubin group; hemoglobin, high density lipoprotein, serum transferrin in low serum direct bilirubin group were lower than high serum direct bilirubin group(p=0.047, p=0.011, p=0.016, p=0.050, p=0.020); Chi-square test show prevalence of malnutrition in low serum direct bilirubin group is higher than high serum direct bilirubin group(P=0.027).(4) serum direct bilirubin negatively correlated with average systolic blood pressure (r=-0.279, p=0.007). The differences are still significant after adjusting the variables of age, gender, diabetes, duration of dialysis, KT/V and parathyroid hormone (p=0.039); serum direct bilirubin negatively correlated with MQSGA and cholesterol (r=-0.282,-0.272; p=0.025,0.010), positively correlated with hemoglobin (r=0.352, p=0.001), adjusted the variables of age, gender, diabetes, duration of dialysis, KT/V, calcium-phosphorus product and parathyroid hormone, cholesterol and hemoglobin are still statistically significant (p=0.021,0.044), MQSGA lost statistical significance.(5) Define MQSGA>10as malnutrition, age, duration of dialysis, serum direct bilirubin are three independent risk factors for malnutrition of PD patients (stepwise method; p=0.054,0.050,0.022);(6) serum direct bilirubin closely associated with NO (r=0.499, p=0.001)。Conclusions:1) serum direct bilirubin<2.0ummol/l is independent related to malnutrition and the increase of systolic blood pressure on CAPD patient;2) Serum serum direct bilirubin can be the reference indicators for the assessment of oxidative stress of CAPD. |
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