连续性肾脏替代治疗对难治性心力衰竭患者心肝肾功能、血清FGF-23、TnT水平的影响

Effect of continuous renal replacement therapy on heart,liver and kidney function and serum FGF-23,TnT levels in patients with refractory heart failure

目的探讨连续性肾脏替代治疗(CRRT)对难治性心力衰竭患者心肝肾功能以及成纤维细胞生长因子(FGF-23)、肌钙蛋白T(TnT)水平的影响。方法选取西安市北方医院2017年1月至2018年1月期间收治的难治性心力衰竭患者64例作为研究对象,采用单双数标记法随机分为对照组和观察组各32例。对照组患者给予常规心力衰竭治疗,观察组患者在对照组治疗的基础上给予CRRT治疗,疗程为1个月。治疗后,比较两组患者的临床疗效、心肝肾功能指标以及血清成纤维细胞生长因子-23(FGF-23)、肌钙蛋白(TnT)水平。结果观察组患者的治疗总有效率为90.63%,明显高于对照组的68.75%,差异具有统计学意义(P<0.05);与治疗前比较,两组患者治疗后的血清FGF-23、TnT水平均明显降低,且观察组患者的血清FGF-23和TnT分别为(0.65±0.19)μg/L、(0.09±0.02)μg/L,明显低于对照组的(0.77±0.12)μg/L、(0.17±0.04)μg/L,差异均具有统计学意义(P<0.05);治疗后,两组患者心肌酶水平、肝功能指标水平均明显改善,且观察组的肌酸激酶、肌酸酶同工酶、谷草转氨酶、乳酸脱氢酶、谷丙转氨酶、总胆红素、直接胆红素、间接胆红素水平均明显低于对照组,差异均有统计学意义(P<0.05)。而两组患者治疗前后的肌酐、尿素、尿酸等肾功能指标水平比较差异均无统计学意义(P>0.05)。结论采用连续性肾脏替代治疗可提高难治性心力衰竭患者的临床疗效,降低血清FGF-23、TnT水平,加快心肝肾功能恢复。

Objective To investigate the effects of continuous renal replacement therapy(CRRT)on heart,liver and kidney function and fibroblast growth factor-23(FGF-23)and troponin T(TnT)levels in patients with refractory heart failure.Methods A total of 64 patients with refractory heart failure,who were treated between January 2017 and January 2018 in Xi’an North Hospital were selected as the research objects,and the patients were randomly divided into the control group and the observation group using the odd and even number mark method,with 32 patients each group.Patients in the control group were given conventional heart failure treatment,and patients in the observation group were given CRRT treatment on the basis of treatment of the control group for 1 month.After treatment,the clinical efficacy,cardiac,liver,and renal function indexes,serum FGF-23,and TnT levels of the two groups of patients were compared.Results The total effective rate of treatment in the observation group was 90.63%,which was significantly higher than 68.75%in the control group(P<0.05).Compared with the pre-treatment,the serum FGF-23 and Tn T levels of the two groups of patients were significantly reduced,and serum FGF-23 and Tn T in the observation group were(0.65±0.19)μg/L and(0.09±0.02)μg/L,which were significantly lower than corresponding(0.77±0.12)μg/L,(0.17±0.04)μg/L in the control group(P<0.05);after treatment,myocardial enzyme levels and liver function index levels of the two groups of patients improved significantly,and the levels of creatine kinase and creatine isozyme,aspartate aminotransferase,lactate dehydrogenase,alanine aminotransferase,total bilirubin,direct bilirubin,and indirect bilirubin in the observation group were significantly lower than those in the control group(all P<0.05).There was no significant difference in the levels of creatinine,urea,uric acid and other renal function indicators between the two groups of patients before and after treatment(all P>0.05).Conclusion Continuous renal replacement therapy can improve the clinical efficacy of patients with refractory heart failure,reduce serum FGF-23,TnT levels,and accelerate the recovery of heart,liver and kidney function.