血液透析联合血液灌流对尿毒症患者透析效率、脂代谢及动脉粥样硬化的影响

Effect of hemodialysis combined with hemoperfusion on dialysis efficiency,lipid metabolism and atherosclerosis in patients with uremia

目的:探讨血液透析(HD)联合血液灌流(HP)对尿毒症患者透析效率、脂代谢及动脉粥样硬化的影响。方法:收集2013年3月~2015年10月间本院收治的尿毒症患者70例,按照双盲随机对照法分为观察组及对照组,各35例。观察组接受血液透析联合血液灌流,对照组仅接受血液透析治疗,持续6个月。干预6个月后,采用全自动生化分析仪检测肾功能指标及脂质代谢指标,采用二维超声定量检测颈动脉粥样硬化参数。结果:干预前,两组肾功能、脂代谢及动脉粥样硬化水平差异无统计学意义(P>0.05);干预6个月后,观察组肾功能指标血尿素氮(BUN)、肌酐(Scr)、β2-微球蛋白(β2-MG)、血尿酸(BUA)水平低于对照组,脂质代谢指标总胆固醇(TC)、甘油三酯(TG)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)含量也低于对照组,组间差异有统计学意义(P<0.05);观察组颈动脉超声定量参数灰阶中位数值(GSM)高于对照组,增强强度(EI)、增强密度(ED)值低于对照组,组间差异有统计学意义(P<0.05)。结论:血液透析联合血液灌流可提高尿毒症患者的透析效率,同时减轻脂质代谢紊乱、延缓动脉粥样硬化形成。

Objective：To study the effect of hemodialysis（HD）combined with hemoperfusion（HP）on dialysis efficiency,lipid metabolism and atherosclerosis in patients with uremia.Methods：A total of 70 patients with uremia who were treated in our hospital between March 2013 and October 2015 were collected and divided into observation group and control group（n=35）according to double-blind randomized control method.Observation group of patients received hemodialysis combined with hemoperfusion,control group of patients received hemodialysis alone,and the treatment lasted for 6months.After6 months of intervention,automatic biochemical analyzer was used to detect renal function indexes and lipid metabolism inde-xes,and the two-dimensional ultrasound was used to quantitatively determine the carotid atherosclerosis parameters.Results：Before intervention,differences in renal function,lipid metabolism and atherosclerosis levels were not statistically significant between two groups of patients（P〉0.05）;after 6months of intervention,renal function indexes blood urea nitrogen（BUN）,serum creatinine（Scr）,β2-microglobulin（β2-MG）and blood uric acid（BUA）levels of observation group were lower than those of control group,lipid metabolism indexes total cholesterol（TC）,triglyceride（TG）,apolipoprotein A1（ApoA1）and apolipoprotein B（ApoB）levels were lower than those of control group,and differences between groups were statistically significant（P〈0.05）;quantitative carotid ultrasound parameters gray-scale median（GSM）of observation group was higher than that of control group,enhanced intensity（EI）and enhanced density（ED）were lower than those of control group,and differences between groups were statistically significant（P〈0.05）.Conclusions：Hemodialysis combined with hemoperfusion can improve the dialysis efficiency,also reduce lipid metabolism disturbance and delay the formation of atherosclerosis in patients with uremia.