血液灌流联合序贯透析对终末期糖尿病肾病患者炎症介质及氧化应激的影响

Effect of blood perfusion combined with sequential dialysis on inflammatory mediators and oxidative stress of end-stage diabetic nephropathy patients

目的:探讨血液灌流联合序贯透析对终末期糖尿病肾病(end-stage diabetic nephropathy,ESDN)患者炎症介质与氧化应激的影响。方法:选取2014年2月至2015年2月来本院进行治疗的180例ESDN患者,按照随机数字表将其分为血液透析(hemodialysis,HD)组、序贯透析(sequential dialysis,SD)组和序贯透析联合血液灌流(sequential dialysis combined with hemoperfusion,S-HFP)组,每组60例。考察治疗前后3组患者的糖代谢指标、体内炎症反应水平,评价治疗前后患者体内氧化应激状态,比较透析充分性和贫血情况。结果:3组患者的空腹血糖、餐后2 h血糖和糖化血红蛋白在治疗前后差异均无统计学意义(P>0.05)。治疗后S-HFP组患者的3项炎症因子指标显著低于其余两组(P<0.05),同时S-HFP组和SD组患者的3项炎症因子指标较治疗前显著降低(P<0.05),而HD组治疗前后炎症因子指标无变化(P>0.05)。治疗后SD组和S-HFP组患者的丙二醛(malondialdehyde,MDA)水平显著低于治疗前水平(P<0.05),而同时过氧化物歧化酶(superoxide dismutase,SOD)和谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)水平显著升高(P<0.05);HD组患者的MDA水平较治疗前显著上升(P<0.05),而SOD和GSH-Px水平显著下降(P<0.05)。3组患者在治疗前体内尿素清除指数(urea clearance index,KT/V)水平差异均无统计学意义(P>0.05),但治疗后S-HFP组患者体内Hb水平显著提高(P<0.05)。结论:对终末期糖尿病肾病患者行序贯透析联合血液灌流,可以有效滤除炎症因子,缓解患者体内氧化应激反应,改善患者贫血状况,效果显著,值得临床推广。

Objective： To investigate the effect of blood perfusion combined with sequential dialysis on inflammatory mediators and oxidative stress of end- stage diabetic nephropathy patients. Methods： 180 patients with end-stage diabetic nephropathy coming to our hospital from February 2014 to February 2015 were randomly divided into three groups , namely hemodialysis group （HD）, sequential dialysis （SD） group and sequential dialysis combined with hemoperfusion（S-HFP） group, 60 cases in each group. Patients in HD group underwent conventional dialysis, while patients in SD group underwent sequential hemodiafiltration, where as patients in S-HFP group underwent sequential hemodiafiltration combined with bemoperfusion. The indexes of glucose metabolism and the levels of inflammatory response in vivo were investigated before and after the treatment. And the oxidative stress state was evaluated. Dialysis adequacy and anemia were compared. Results： Three groups of patients showed no significant difference on FBG, P2hBG and HbA1 c levels before and after the treatment （P 〉 0.05 ）. After the treatment three indexes of inflammatory factor in S- HFP group were significantly lower than those of the other two groups （P 〈 0.05 ）. At the same time, three indexes of inflammatory factor in S-HFP group and SD group significantly decreased compared with those before the treatment （ P 〈 O. 05 ）. However there were no significant differences in inflammatory factors in HD group before and after the treatment （ P 〉 O. 05 ）. After the treatment, the MDA levels in patients of S- HDF group and S- HFP groups were significantly lower than those before the treatment （ P 〈 0.05 ）, while the levels of SOD and GSH PX increased significantly （ P 〈 0.05 ）. MDA levels in patients of HD group significantly increased after the treatment compared with those before the treatment （ P 〈 0.05 ）. However the level of SOD and GSH PX decreased significantly （ P 〈 0.05 ）. There were no significant differences in KT/V levels between the three groups before and after the treatment （P 〉 0.05 ）. But the level of Hbof patients in S- HFP group was significantly increased after the treatment （ P 〈 0. 05 ）. Conclusion： For patients with end-stage diabetic nephropathy, undergoing sequential hemodialysis combined with hemoperfusioncan can effectively remove inflammatory factors, improve anemia status and alleviate oxidative stress. It is worthy of promotion.