摘要
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.
出处
《中国中西医结合肾病杂志》
2014年第3期219-222,共4页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
上海市科委医学引导项目(No.124119b1100)