高通量血液透析对糖尿病肾病患者预后的影响

The effect of high-flux hemodialysis on the prognosis of patients with diabetic nephropathy

目的探讨高通量血液透析对糖尿病肾病患者预后的影响。方法选取2011年7月至2013年9月就诊于本院的88例糖尿病肾病血液透析患者为研究对象,按随机数表法将其分为高通量组(44例)与低通量组(44例),并分别给予高通量血液透析与低通量血液透析治疗,比较两组患者预后情况,应用荧光光谱法检测两组患者前臂内侧皮肤组织中的晚期糖基化终末产物(advanced glycation end products,AGEs)的水平,分析AGEs水平与糖尿病肾病并发症发生率之间的相关性。结果高通量组患者并发心脑血管疾病的发生率[15.91%(7/44)]显著低于低通量组[25.00%(11/44)](P<0.05);治疗后1年,高通量组患者的生存率[93.18%(41/44)]高于低通量组[81.82%(36/44)],但并无显著性差异(P>0.05);治疗后3年,高通量组患者的生存率[84.09%(37/44)]明显高于低通量组[61.36%(27/44)](P<0.05)。经荧光光谱法检测AGEs水平,两组中心脑血管疾病并发症患者的接受者操作特征曲线(receiver operating characteristic curve,ROC曲线)下面积分别为0.97 nm^2和0.87 nm^2,均高于两组中无心脑血管疾病并发症患者的ROC曲线下面积(0.61 nm^2和0.51 nm^2)。高通量组患者AGEs水平[(6.59±1.22)μg/ml]显著低于低通量组[(11.09±2.38)μg/ml](P<0.05)。结论高通量血液透析可有效降低糖尿病肾病患者并发心脑血管疾病的发生率,提高患者的生存率,保障其远期生存质量;检测AGEs水平对未来糖尿病肾病并发症的发生具有预警作用,并为糖尿病肾病的病情预测及评估提供重要的临床依据。

Objective To investigate the therapeutic effects of high-flux hemodialysis on the prognosis of patients with diabetic nephropathy. Method 88 cases of patients with diabetic nephropathy from July 2011 to Sepetember 2013 in our hospital were selected as the research objects, and they were randomly divided into high-flux group（44 cases, treated with high-flux hemodialysis） and low-flux group（44 cases, treated with low-flux hemodialysis）, the prognosis of the two groups were compared; the application of fluorescence spectroscopy of the two groups patients with medial forearm skin tissues were detected by advanced glycation end products（AGEs）, the correlation between the incidence of complications and the level of AGEs were analyzed. Result The incidence of cardiovascular and cerebrovascular diseases of high-flux group [15.91%（7/44）] was lower than low-flux group [25.00%（11/44）]（P〈0.05）. 1 year after treatment, the survival rate of high-flux group [93.18%（41/44）] was higher than low-flux group [81.82%（36/44）], but there was no significant difference between the two groups（P》0.05）. 3 years after treatment, the survival rate of high-flux group [84.09%（37/44）] was higher than low-flux group [61.36%（27/44）]（P〈0.05）. And the level of AGEs was detected by fluorescence spectrometry. The area under receiver operating characteristic curve（ROC curve） was respectively 0.97 nm^2 and 0.87 nm^2 of patients with cardiovascular and cerebrovascular diseasesin high-flux group and low-flux group, which were both higher than patients without cardiovascular and cerebrovascular diseases（0.61 nm^2 and 0.51 nm^2）. The levels of AGEs of high-flux group [（6.59±1.22） μg/ml] was lower than low-flux group [（11.09±2.38） μg/ml]（P〈0.05）. Conclusion High-flux hemodialysis can effectively reduce the incidence of cardiovascular and cerebrovascular disease in patients with diabetic nephropathy, and improve the survival rate and quality of life. By detecting the concentration of AGEs in the future, it can play an early warning role in the future of diabetic nephropathy, and provide an important clinical basis for prediction and evaluation of diabetic nephropathy.