高通量血液透析对老年糖尿病肾病患者胰岛素抵抗及微炎症状态的影响

Effect of high-flux hemodialysis on insulin resistance and microinflammatory state in elderly diabetic nephropathy patients with maintenance hemodialysis

目的观察高通量血液透析（血透）对老年糖尿病肾病患者胰岛素抵抗（IR）和微炎症状态的影响。方法选择我中心老年糖尿病肾病维持性血透患者（透析组）49例及健康体检老年人（对照组）10例，比较两组胰岛素抵抗指数（HOMArIR）、白细胞介素-6（IL-6）、高敏C反应蛋白（hs-cRP）水平，并进行相关性分析。随机将患者分为高通量透析和低通量透析两组，治疗12个月，分别观察两组患者治疗前、后HOMA—IR、IL-6、hs—CRP、尿素清除率（kt／v）等指标的变化。结果老年透析组患者IL-6、hs—CRP和HOMA-IR水平均显著高于对照组，分别为（126．22±13．23）ng／L比（12．68±3．63）ng／L、（12．13±1．73）mg／L比（2．55±1．27）mg／L和4．83±1．23比0．32±0．15，差异均有统计学意义（P〈O．01）；IL-6、hs—CRP均与HOMA—IR呈正相关（R=0．656、0．729，R2=0．43、0．532，均P〈0．01）。治疗12个月后，高通量组空腹胰岛素、HOMA—IR、IL-6较治疗前明显降低（P〈0．05）；与低通量组比较，空腹胰岛素、HOMA-IR、hs—CRP显著降低（P〈0．05）。低通量组空腹胰岛素、HOMA-IR、IL-6、hs—CRP治疗前、后比较，差异无统计学意义（P〉O．05）。结论老年糖尿病肾病维持性血透患者体内普遍存在IR和微炎症状态；高通量透析较低通量透析能有效改善其IR，降低IL-6、s-7k平．曲善衢弗痒精杰．

Objective To investigate the effect of high-flux hemodialysis on insulin resistance and microinflammatory state in elderly diabetic nephropathy （DN） patients with maintenance hemodialysis（MHD）. Methods A total of 49 elderly DN patients with MHD and 10 healthy controls undergoing health examination survey were enrolled. Levels of homeostasis model assessment of insulin resistance index（HOMA-IR）, interleukin-6 （IL-6） and high sensitivity C-reactive protein（hs- CRP） were analyzed and compared between patients and the controls. Patients with MHD were randomly divided into two groups： high-flux hemodialysis（HFHD） group and low-flux hemodialysis （LFHD） group. Changes of the parameters including HOMA-IR, IL-6, hs-CRP and urea excretion rate（kt/v） were observed before and after treatment for 12 months. Results Levels of IL-6, hs-CRP and HOMA-IR were significantly higher in DN patients with MHD than in the control group [（126.22±13.23）ng/L vs. （12.68±3.63）ng/L,（12.13±1.73）mg/L vs. （2.55±1.27） rag/L, （4.83 ±1.23） vs. （0.32±0.15）, respectively, all P〈0.013. The levels of IL-6 and Hs-CRP were positively correlated with HOMA-IR in elderly DN patients（R = 0. 656, 0. 729, R2 = 0.43, 0. 532, both P%0.01）. Compared with before treatment, levels of fasting insulin（Fins）, HOMA-IR and IL-6 were decreased in HFHD group after MHD for 12 months （all P〈0.05）, while there were nodifferences in levels of Fins, HOMA IR, IL-6 and hs-CRP in the LFHD group before and after MHD （all P）0.05）. The levels of Fins, HOMA-IR and IL-6 were significantly lower in the HFHD group than in the LFHD group after MHD for 12 months（all P〈0.05）. Conclusions Insulin resistance and microinflammatory are common observed in elderly DN patients with MHD. High-flux hemodialysis may decrease the levels of IL-6 and hs-CRP, and ameliorate insulin resistance and microinflammatory state.