血液灌注联合血液透析对慢性肾脏病患者炎症状态、矿物质、骨代谢及肾功能的临床效果分析

Clinical effect of hemoperfusion combined with hemodialysis on inflammatory state,minerals,bone metabolism and renal function in patients with chronic kidney disease

目的:探讨联合血流灌注与血液透析对慢性肾脏病患者炎症状态、矿物质、骨代谢和肾功能的影响。方法:选取2016年3月~2018年12月在我院接受血液透析治疗的70例HD合并CKD患者作为研究对象,将患者随机分为对照组和联合组,各35例。对照组给予血液透析治疗,联合组患者给予血液透析和血流灌注联合治疗。评价、观察并比较两组患者的临床治疗效果和并发症的发生情况,检测并比较治疗前后两组患者炎症因子、矿物质代谢指标和肾功能指标变化情况。结果:(1)联合组患者治疗总有效率为94%,对照组为77%;治疗过程中总并发症发生率比较差异无统计学意义(45.7%与34.3%)。(2)治疗后两组患者TNF-α、IL-6、NLR明显降低,且联合组显著低于对照组;(3)治疗后血Ca明显升高,血P和ALP明显降低,且联合组治疗后血Ca显著高于对照组,血P和ALP均显著低于对照组;对照组治疗后骨密度较治疗前显著降低,联合组治疗前后骨密度比较无显著性差异。(4)治疗后组患者肾功能指标SCr和BUN较治疗前均明显降低,且联合组低于对照组。结论:HP联合HD应用于HD合并CKD患者治疗效果确切,改善炎症状态、矿物质、骨代谢和肾功能,且不增加不良反应的发生率。

Objective To investigate the effects of hemoperfusion combined with hemodialysis on inflammatory state,minerals,bone metabolism and renal function in patients with chronic kidney disease.Methods Seventy patients with HD and CKD who underwent hemodialysis in our hospital from March,2016 to December,2018 were enrolled in the study.They were randomly divided into control group and combined group,35 cases each.The control group was given hemodialysis treatment,and the combined group was given hemodialysis and hemoperfusion combined therapy.The clinical treatment effects and complications of the two groups were evaluated,observed and compared.The changes of inflammatory factors,mineral metabolism indexes and renal function indexes were detected and compared before and after treatment.Results(1)The total effective rate was 94%in the combined group and 77%in the control group.There was no significant difference in the total complication rate during the treatment(45.7%vs.34.3%).(2)After treatment,TNF-α,IL-6 and NLR were significantly decreased in the two groups,and the combination group was significantly lower than the control group.(3)The blood Ca increased significantly after treatment,and the blood P and ALP were decreased.After the treatment,the blood Ca was significantly higher than the control group,and the blood P and ALP were significantly lower than the control group.The bone mineral density of the control group was significantly lower than that before the treatment.There was no significant difference in bone mineral density before and after treatment.(4)The renal function indexes SCr and BUN of the patients after treatment were significantly lower than those before treatment,and the combination group was significantly lower than the control group.Conclusion HP combined with HD is effective in the treatment of patients with HD and CKD,improving inflammatory status,minerals,bone metabolism and renal function,and does not increase the incidence of adverse reactions.