HD+HP对老年终末期肾病动脉粥样硬化及心血管并发症的预防效果

Preventive effect of HD+HP on atherosclerosis and cardiovascular complications in elderly patients with end-stage renal disease

目的探讨血液透析(hemodialysis,HD)联合血液灌流(hemoperfusion,HP)对老年终末期肾病(end stage renal disease,ERSD)患者动脉粥样硬化及心血管并发症的预防效果。方法将行维持性HD的60例老年ESRD患者按随机数字表法分为2组各30例。观察组接受HD+HP,对照组仅行HD。治疗前、治疗后6个月,采集患者空腹静脉血检测对比2组载脂蛋白C3(apolipoprotein C3,ApoC3)、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、C反应蛋白(C-reactive protein,CRP)、血红蛋白(hemoglobin,Hb)、白蛋白(albumin,ALB)、白细胞介素6(interleukin-6,IL-6)、白细胞介素8(interleukin-8,IL-8)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)水平,检测患者颈动脉内中膜厚度(carotid intima-media thickness,CIMT),统计心血管并发症发生率。结果 (1)治疗后6个月:对照组IL-6、IL-8明显下降(P<0.05);观察组IL-6、IL-8、ApoC3、TG、CRP明显下降,HDL、ALB明显上升(P<0.05);观察组IL-6、IL-8下降程度明显大于对照组,差异有统计学意义(P<0.05)。(2)治疗后6个月:对照组CIMT明显上升,与治疗前比较差异有统计学意义(P<0.05),而观察组CIMT未见明显变化;非条件Logistic回归分析显示ApoC3、TG、IL-6和CRP是CIMT增厚的独立危险因素,HDL是CIMT增厚的独立保护因素(P<0.05)。(3)观察组心肌损害及心力衰竭发生率均明显低于对照组,差异有统计学意义(P<0.05)。结论 HD+HP有助于抑制老年ERSD动脉粥样硬化的形成,这可能与其对ApoC3、TG及CRP的抑制作用有关,有助于降低多种心血管并发症的发生率。

Objective To investigate the preventive effect of hemodialysis （HD） combined with hemoperfusion（HP） on atherosclerosis and cardiovascular complications in elderly patients with end stage renal disease（ERSD）. Methods Sixty cases of elderly patients with ESRD treated by maintenance hemodialysis in our hospital were included and randomly divided into 2 groups, with 30 cases in each group, by random number table. The observation group was treated with HD＋ HP, while the control group was treated with sole HD. Fasting blood samples were collected before and 6 months after treatment, in order to detect and compare the level of apolipoprotein C3 （ApoC3）, high density lipoprotein （ HDL）, low density lipoprotein （ LDL）, triglyceride（TG）, total cholesterol（TC）, C-reactive protein（CRP）, hemoglobin（Hb）, albumin （ALB）, interleukin-6 （IL-6）, interleukin-8 （IL-8）, tumor necrosis factor-a （TNF-a）, carotid intima-media thickness（CIMT）of patients were also detected. The incidence of cardiovascular complications were recorded. Results ①6 months after treatment, IL-6 and IL-8 in the control group were significantly decreased （P〈0.05）. While IL-6, IL-8, ApoC3, TG and CRP in the observation group were decreased significantly, HDL and ALB in the observation group were increased significantly（P〈0.05）. The decreasing of IL-6 and IL-8 in the observation group were more obvious than in the control group, the differences were statistically significant（P〈0.05）. ②6 months after treatment, CIMT in the control group was increased significantly（P〈0. 05） compared with before treatment. While CIMT in the observation group did not change obviously. Non-conditional logistic regression analysis showed that APOC3, TG, IL-6 and CRP were independent risk factors for CIMT thickening, and HDL was an independent protective factor for CIMT thickening（P〈0.05）.③The incidence rate of myocardial injury and heart failure in the observation group were significantly lower than those in the control group, the differences were statistically significant （P〈0.05）. Conclusion HD ＋ HP can inhibit the formation of atherosclerosis in elderly patients with end stage renal disease, which may be related to the inhibition of ApoC3, TG and CRP. This will help to reduce the incidence of various cardiovascular complications.