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Objective:To investigate the efficacy and safety of peritoneal dialysis (PD) in end-stage renal disease (ESRD) patients with liver cirrhosis (LC).Methods:Clinical data of PD patients receiving regular treatment followed up for≥6 months, and aged≥18 years in the Third Affiliated Hospital of Hebei Medical University Peritoneal Dialysis Center from January 1, 2013 to March 31, 2020 were retrospectively collected. The patients were divided into LC-PD group and non-LC-PD group according to whether they had LC or not. Propensity score matching (PSM) was used to match the LC-PD group and the non-LC-PD group with 1∶4 ratio. The baseline clinical data, dialysis adequacy, peritonitis and clinical outcomes between the two groups were compared. Kaplan-Meier survival curve and Log-rank test were used to compare the survival rate and technical survival rate between the two groups.Results:A total of 241 PD patients were included in this study. After PSM, 13 cases in LC-PD group and 52 cases in non-LC-PD group were included. Compared with non-LC-PD group, patients in LC-PD group had lower baseline urine volume ( Z=-3.546, P<0.001) and serum albumin ( Z=-2.609, P=0.009). At the follow-up of 3, 6, 12 and 24 months, total serum protein ( t=-3.319, P=0.002), serum albumin ( t=-4.019, P<0.001), triglyceride ( Z=-2.263, P=0.024), and serum phosphorus ( Z=-2.173, P=0.030) in the LC-PD group were lower than those in non-LC-PD group. During the follow-up period of 2 years, the patients in the LC-PD group had significantly higher serum albumin than baseline values ( χ2=16.901, P=0.001), and there was no statistically significant difference between the two groups ( χ2=0.155, P=0.694). The decline rate of residual kidney Kt/V in the LC-PD group was slower than that in the non-LC-PD group ( χ2=44.589, P<0.001). The incidence of peritonitis in LC-PD group was higher than that in the non-LC-PD group, with a statistically significant difference (0.59/patient-year vs 0.20/patient-year, Z=-2.135, P=0.033). The composition ratio of pathogenic bacteria in both groups was mainly gram-positive bacteria (10/25 vs 11/30) and proportion of Streptococcus in LC-PD group was higher than that in non-LC-PD group (4/10 vs 0/11, P=0.035). The proportion of Escherichia coli in the first peritonitis was higher than that in LC-PD group (4/9 vs 1/22, P=0.017). The Kaplan-Meier survival curve results showed no statistically significant difference in survival rate (Log-rank χ2=0.491, P=0.484) and technical survival rate (Log-rank χ2=0.408, P=0.523) between the two groups. Conclusions:PD is a safe and effective treatment mode for ESRD patients with LC, and the survival rate and technical survival rate are comparable to those patients without LC. The incidence of peritonitis in patients with LC-PD in our dialysis center is higher than that in the non-LC-PD patients, and gram-positive bacterial infections are the mainstay, suggesting that attention should be paid to strengthening patient management and training.
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Objective To conduct the contrastive analysis on the indwelling time of fixing indwelling needle by cutting sterile transparent dressing and non-cutting sterile transparent dressing.Methods A total of 236 inpatients in this hospital from August to December 2016 were selected.The patients with odd at last number of admission number served as the experimental group (119 cases),while the patients with even at the last number of admission number served as the control group(117 cases).The indwelling needle type was 18GA,the puncture was once success and the fluid infusion course was more than 5 d.The experimental group used the cutting sterile transparent dressing for fixing the indwelling needle and the extension tube vas completely exposed to the outside of dressing,while the control group adopted the conventional indwelling needle application fixation mode.The blood returning plugging pipe rate,average indwelling time and phlebitis occurrence at 24,48,72,96,＞ 96 h after indwelling needle were recorded.Results The blood returning plugging tube situation at 48,72,96,＞96 h after indwelling needle in the experimental group was superior to that in the control group,the difference was statistically significant(P＜0.05);the average indwelling time in the experimental group was (72.12 ± 3.25)h,while which in the control group was (59.34--3.78) h,and the difference was statistically significant (P＜0.05).Seven cases of phlebitis occurred in the experimental group and 9 cases in the control group,the difference was not statistically significant(P＞0.05).Conclusion Applying cutting sterile transparent dressing for fixing the indwelling needle reduces the plugging pipe rate due to returning blood coagulation,extends the indwelling needle use time,increase the patient's satisfaction,moreover does not increase the phlebitis occurrence risk.
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Objective To explore the mechanism that Staphylococcus aureus(S.aureus) α-toxin(Hla) regulate miR-142 expression and inhibit macrophage phagocytosis.Methods BALB/C mice and RAW264.7 cells were infected with wild type S.aureus(WT S.aureus),Hla deletion S.aureus(△HlaS.aureus) or phosphate buffered saline(PBS),and the expression level of miR-142 of skin tissues and cells were detected.miR-142 mimics and inhibitor were then applied in the RAW264.7 culture to examine the effect on phagocytosis.Direct targeting of miR-142 on protein kinase Cα(PKCα) was assessed by luciferase assay and western blotting.Results miR-142 expression in △HlaS.aureus group were significantly down-regulated than WT S.aureus group(P<0.05).MiR-142 mimics inhibited RAW264.7 phagocytosis ability and inhibitor enhanced RAW264.7 phagocytosis ability.PKCα was directly targeted by miR-142.MiR-142 mimics significantly decreased the mRNA expression levels of PKCα in RAW264.7 cells(P<0.05).Conclusion Hla could promote miR-142 expression in macrophages.MiR-142 could inhibit macrophage phagocytosis through down-regulated PKCα.
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Objective To analyze the nutritional status of patients with continuous ambulatory peritoneal dialysis and explore reasonable and effective nursing measures.Methods Nutritional assessment was performed in 60 patients with continuous ambulatory peritoneal dialysis,using subjective integrated nutritional assessment,dietary analysis,measurement of biochemical indexes of the human body to analyze the factors that might affect the nutritional status of patients.Results 60 cases of malnutrition occurrd in 20 patients (33.3per cent),mainly due to insufficient protein and energy intake,inadequate dialysis,peritoneal inflammation,metabolic acidosis,psychosocial factors and not using erythropoietin,and so on.Conclusions Measures such as emphasis paid to malnutrition status of continuous ambulatory peritoneal dialysis patients,giving guidance of rational diet,performing full implementation of nursing measures according to the related factors,can improve the nutritional status of patients and improve patients' quality of life.