血液灌流串联血液透析治疗对终末期糖尿病肾病患者胰岛素抵抗与营养状态的影响

Hemoperfusion Union Hemodialysis Treatment for the Relationship betwen Insulin Resistance and Malnutrition in the End-stage Diabetic Nephropathy( ESDN) Patients

目的:探讨血液灌流串联血液透析治疗对终末期糖尿病肾病(ESDN)患者胰岛素抵抗、微炎症状态与营养不良的关系。方法:入选ESDN患者75例,其中单纯血液透析组(HD组)25例、血液透析联合血液滤过组(HD+HDF组)28例、血液透析串联血液灌流组(HD+HP组)22例,比较各组患者治疗前、后与胰岛素抵抗、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血红蛋白(Hb)、血清白蛋白(Alb)、空腹胰岛素(FINS)、空腹血糖(FBS)及体重指数(BMI)的相关性,应用Daugirdas公式计算透析充分性(KT/V),分析血液灌流串联血液透析对ESDN患者胰岛素抵抗、微炎症状态与营养不良的影响;健康人16例作为对照组。结果:治疗前,3组胰岛素抵抗、微炎症状态与营养状态差异无统计学意义(P>0.05),而CRP、TNF-α及IL-6均高于正常对照组(P<0.001);治疗12周后,血液灌流治疗与胰岛素抵抗、CRP、TNF-α、IL-6、Hb、Alb及BMI均显著相关;胰岛素抵抗和营养状态:HD+HP组治疗前后有改善(P<0.05),较HD组和HD+HDF组差异有统计学意义(P<0.05);炎症因子:HD+HP组治疗前后、以及较其他两组显著降低(P<0.01),较正常对照组仍增高(P<0.05),HD+HDF组与HD组之间差异也有统计学意义(P<0.05),HD组治疗前后差异无统计学意义(P>0.05)。结论:血液透析的ESDN患者体内长期存在的胰岛素抵抗、微炎症状态和营养不良,血液灌流可有效清除炎症介质,降低ESDN患者的胰岛素抵抗,改善营养状态。

Objective：To explore hemoperfusion union hemodialysis treatment for the relationship among insulin resistance and micro-inflammation and malnutrition in the end-stage diabetic nephropathy （ESDN） patients.Methods：There were 75 patients with ESDN who were devided into three groups：25 cases were treated by simply hemodialysis （HD group）in the first group,28 cases were treated by hemodialysis combined with hemofiltration group （HD ＋ HDF group）） in the second group and 22 were treated by cases hemodialysis series hemoperfusion group （HD ＋ HP group） in the third group,To compare correlation with situations of patients who were before and after treatment in various groups including：insulin resistance,C-reactive protein （CRP）,tumor necrosis factor-α （TNF-α）,interleukin-6 （IL-6）,hemoglobin （Hb）,serum albumin （Alb）,fasting insulin （FINS）,fasting blood glucose （FBS） and body mass index （BMI）.To applicate Daugirdas formula for dialysis adequacy （KT/V） and analysis impact of hemoperfusion series hemodialysis treatment for ESDN patients,insulin resistance,micro-inflammation and malnutrition,including 16 cases of healthy people as a control group.Results：Before treatment,there was no significant difference from insulin resistance,inflammation and micro-nutrient status in three groups （P ＞ 0.05）,However,CRP,TNF-α and IL-6 in three groups were higher than those in the control group （P ＜ 0.01） ;After 12 weeks hemoperfusion therapy,there were significantly association with hemoperfusion therapy and those indicators which were insulin resistance,CRP,TNF-α,IL-6,Hb,Alb and BMI ; Insulin resistance and nutritional status were improved after HD ＋ HP treatment （P ＜ 0.05）,there was statistical significance comparing with those only by HD and those by HD ＋ HDF （P ＜ 0.05） ; inflammatory factors were higher before treatment than after treatment,inflammatory factors in HD ＋ HP group were significantly lower than the other two groups（P ＜ 0.001）,and higher than the normal control group （P ＜ 0.05）,there was statistical significance between only by HD and those by HD ＋ HDF （P ＜ 0.05）,There was no statistical significance （P ＞ 0.05） between those factors before and after treatment in HD group.Conclusion：ESDN patients treated by hemodialysis had those stiations that were insulin resistance,micro-inflammation and malnutrition.Hemoperfusion could effectively remove inflammatory mediators,reduce ESDN patients insulin resistance,and improve the nutritional status.