高通量血液透析和血液灌流联合血液透析治疗终末期糖尿病肾病患者的效果观察

Effects observation of high flux hemedialysis and hemoperfusion combined with hemodialysis in the treatment of patients with end-stage diabetic nephropathy

目的比较高通量血液透析和血液灌流联合血液透析治疗终末期糖尿病肾病的效果。方法选取2011年5月~2015年4月我院的86例终末期糖尿病肾病患者作为研究对象,随机分为研究组和对照组,各43例。对照组给予高通量血液透析,研究组给予血液灌流联合血液透析。比较两组治疗前后的营养指标、微炎症状态及血脂改善情况。结果两组治疗后6个月的RBC、HGB、Alb、维生素B12、叶酸水平显著高于治疗前,差异有统计学意义（P〈0.05）。研究组治疗后的RBC、HGB水平低于对照组,Alb、维生素B12、叶酸水平高于对照组,差异有统计学意义（P〈0.05）。两组治疗后6个月的hs-CRP、β2-MG、IL-6水平显著低于治疗前,差异有统计学意义（P〈0.05）。研究组治疗后6个月的hs-CRP、β2-MG、IL-6水平显著低于对照组治疗后,差异有统计学意义（P〈0.05）。两组治疗后6个月的TC、TG、LDL-C水平显著低于治疗前,HDL-C水平显著高于治疗前,差异有统计学意义（P〈0.05）。研究组治疗后6个月的TC、TG、LDL-C水平显著低于对照组,HDL-C显著高于对照组治疗后,差异有统计学意义（P〈0.05）。结论高通量血液透析和血液灌流联合血液透析均是治疗终末期糖尿病肾病的有效方式,各有优缺点,临床需根据具体情况选择。

Objective To compare effects of high flux hemedialysis（HFHD） and hemoperfusion combined with hemodialysis（HP ＋HD） in the treatment of end-stage diabetic nephropathy.Methods 86 cases of patients with end-stage diabetic nephropathy from May 2011 to April 2015 in our hospital were selected and randomly divided into the research group and the control group,43 cases in each group.The control group was treated with HFHD,the research group was treated with HP ＋HD.The improvement situation of nutrition indicators,micro-inflammation state and blood lipid in the two groups was compared.Results The levels of red blood cells（RBC）,hemoglobin（HGB）,serum albumin（Alb）,vitamin B12 and folic acid after treatment of 6 months in the two groups was higher than that before treatment,with significant difference（P〈0.05）.The level of RBC and HGB in the research group after treatment of 6 months was lower than that in the control group after treatment of 6 months,the levels of Alb,vitamin B12 and folic acid in the research group after treatment of 6 months was higher than that in the control group after treatment of 6 months,with significant difference（P〈0.05）.The levels of high sensitive C reactive protein（hs-CRP）,β2microglobulin（β2-MG） and interleukin-6（IL-6） after treatment of 6 months in the two groups was lower than that before treatment,with significant difference（P〈0.05）.The level of hs-CRP,β2-MG and IL-6 in the research group after treatment of 6 months was lower than that in the control group after treatment of 6 months,with significant difference（P〈0.05）.The levels of total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C） after treatment of 6 months in the two groups was lower than that before treatment,the levels of high density lipoprotein cholesterol（HDL-C） after treatment of 6 months in the two groups was higher than that before treatment,with significant difference（P〈0.05）.The level of TC,TG,LDL-C in the research group after treatment of 6 months was lower than that in the control group after treatment of 6 months,the levels of HDL-C in the research group after treatment of 6 months was higher than that in the control group after treatment of 6 months,with significant difference（P〈0.05）.Conclusion HFHD and HP ＋HD are both effective for patients with end-stage diabetic nephropathy,each have advantages and disadvantages.In clinical practice,the treatment should be selected according to the specific circumstances.