血液透析与血液灌流联合治疗尿毒症心包积液随机对照研究

RCT on pericardial effusion of uremic patients treated by HD and HP

目的探讨血液透析(HD)与血液灌流(HP)联合治疗对尿毒症患者心包积液的临床价值。方法选择2013年10月至2015年12月在中国医科大学附属盛京医院就诊的尿毒症合并心包积液患者88例,随机分为对照组和观察组,每组各44例患者,观察组患者行HD与HP联合治疗,对照组患者通过HD进行治疗。比较两组患者治疗前与治疗8周后血清C反应蛋白(CRP)等炎性因子水平以及心功能、心包积液量的变化。结果观察组治疗后血液甲状旁腺激素(PTH)水平[(301.7±92.4)ng/L]、炎症因子CRP[(13.2±1.4)mg/L]明显低于治疗前[PTH和CRP分别为(611.2±190.1)ng/L和(41.6±11.7)mg/L],血肌酐水平也显著下降[治疗前后分别为(689.0±251.0)μmol/L和(373.0±57.2)μmol/L),差异具有统计学意义(P<0.05)。观察组治疗后的各项检测指标与对照组相比,差异均有统计学意义(P<0.05),心包积液量也明显低于对照组,心功能改善优于对照组,差异均具有统计学意义(P<0.05)。结论HD与HP联合治疗尿毒症心包积液能更有效地清除炎症因子,减轻心包积液程度,改善心功能。

Objective To investigate the effect ofhemodialysis （HD） and hemoperfusion （HP） combination therapy on pericardial effusion and inflammatory factors in uremic patients. Methods 88 cases of uremic patients with pericardial effusion in China Medical University Shengjing Hospital were studied during October 2013-December 2015. All cases were divided into a control group and an observation group by random number table method. The 44 patients in the observation group were treated by HD and HP combination therap）5 and the control group of 44 patients were treated by conventional HD methods. Measure the heart function and the volume of pericardial effusion, as well as levels of inflammatory cytokines CRP ,serum PTH and Cr during the study. Results After treatment,we found that the volume of pericardial effusion, serum CRP（13.2±1.4 mg/L） ,PTH（301.7±92.4 ng/L） and Cr 373.0±57.2 μmol/Llevels in the observation group were significantly lower than those in the control group（CRP, PTH and Cr is respectively 41.6±11.7 mg/ L, 611.2±190.1 ng/L and 689.0±251.0 μmol/L）（P 〈0.05）. After treatment,.the heart fimction in observation group wwa significantly better than that in the control group, （P 〈0.05）. Conclusion HD and HP combination therapy for uremia patients with pericardial effusion can reduce serum inflammatory factors and volume ofpericardial effusion,and inprove the heart function significantly.