血液透析滤过对终末期肾病患者BNP及胰岛素抵抗的影响

The Effects of Hemodiafiltration on B-type Brain Natriuretic Peptide and Insulin Resistanc in Patients with End Stage Renal Diseases

目的:观察血液透析滤过对终末期肾病患者BNP及胰岛素抵抗的影响,探讨血液透析滤过(HDF)对维持性血液透析患者心血管疾病改善的作用机制。方法:将107例终末期肾病患者随机分为常规血液透析组(HD)和血液透析滤过组(HDF),HDF组在常规透析基础上,每2周行血液透析滤过一次,4h/次。观察比较治疗6个月后HD组和HDF组患者BNP、HOMA-IR、hs-CRP、体质量指数(BMI)、胆固醇、高密度脂蛋白、甘油三酯、尿酸等指标的变化,分析干预治疗6个月后BNP与各变量间的相关性。结果:基线水平HD和HDF两组间各项指标比较差异无统计学意义(P>0.05)。干预治疗6个月后HD与HDF组患者体重指数、总胆固醇、高密度脂蛋白、甘油三酯比较差别均无统计学意义(P>0.05)。HDF组BNP、HOMA-IR、尿酸、hs-CRP水平明显低于HD组(P<0.05或P<0.01)。HOMA-IR与BNP有显著相关关系(r=0.49,P<0.01),BNP、HOMA-IR与BMI(r=0.25,P<0.05;r=0.58,P<0.01)、尿酸(r=0.23,P<0.05;r=0.26,P<0.05)、hs-CRP(r=0.44,P<0.01;r=0.31,P<0.01)有显著正相关关系。HOMA-IR、尿酸、hs-CRP是终末期肾病血透患者BNP水平主要影响因素。结论:在终末期肾病血液透析患者HOMA-IR与BNP有显著相关性,HDF在改善透析患者胰岛素抵抗及微炎症状态及降低BNP水平方面,比普通血液透析具有更大的优势。

Objective： To observe the influence of hemodiaf/ltrat/on （ HDF ）on B-type brain uatriuretic peptide and insulin resistanc in maintence hemodialysis patients and to investigate the mechanism of role which HDF relieve cardiovascular disease in patients with MHD.Method： 107 cases patients with MHD were randomly divided into two groups, HD （ treated with HD ） and HDF （ treated with HDF every two weekly in addition to I-ID ） .The patients serum BNP, HOMA-IR, hs-CRP, BMI, cholesterin, HDL, triglyceride, uric acid were detected after 6 months.Analysing the correlation of BNP and the other variables after 6 months for ： Indicators of HD and HDF groups in Baseline levels have no statistical significance （ P〉0.05 ） .After 6 months observation, the levels of BMI, total cholesterol, HDL, triglyceride in two groups have no statistical significance （ P〉0.05 ）, the levels of BNP, HOMA-IR, hs-CRP and uric acid were significantly decreased according to HD groups （ P〈0.05 or P〈0.01 ） .HOMA IR and BNP have significant correlation （r=0.49, P〈0.01 ） .The BNP and HOMA IR were significantly positive correlation to BMI （r=0.25, P〈0.05; r=0.58, P〈0.01 ）, uric acid （ r=0.23, P〈O.05 ; r=-0.26, P〈0.05 ） and hs-CRP （ r=0.44, P〈0.01 ; r=0.31, P〈0.01 ） .HOMA IR, uric acid and the hs-CRP are the main influencing factors of BNP levels in patients with end-stage renal diseases.Conclusioni HOMA-IR has significant correlation with the BNP in hemodialysis patients with end-stage renal disease.HDF could better reduce insulin resistance and microinflammation state than HD therapy, which may also reduce the level of BNP.