血液透析滤过联合乌司他丁对糖尿病酮症酸中毒患者炎症因子的作用

Effects of HDF and ulinastatin on inflammatory factors in DKA patients

目的:探讨血液透析滤过(HDF)联合乌司他丁对糖尿病酮症酸中毒(DKA)患者血糖、酸中毒、炎症因子和脂联素水平的作用。方法:100例DKA患者随机分为对照组和观察组,每组50例。2组患者均接受DKA常规治疗,对照组在此基础上接受HDF治疗,观察组接受HDF联合乌司他丁静脉滴注,疗程均为2周。检测2组患者治疗前后空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、血乳酸(Lac)、二氧化碳结合力(CO2CP)、p H值、尿酮体、脂联素(APN)、C反应蛋白(CRP)和TNF-α水平。结果:治疗后,观察组FBG、Hb A1c和Lac水平较对照组下降更明显(P<0.05)。2组患者CO2CP水平升高(P<0.05),p H值恢复正常(P<0.05)。与对照组比较,观察组尿酮体转阴和p H值纠正时间均显著缩短(均P<0.05)。治疗后,2组患者CRP和TNF-α水平降低(P<0.05),APN水平升高(P<0.05);且观察组CRP和TNF-α水平低于对照组(均P<0.05),APN水平高于对照组(均P<0.05)。结论:血液透析滤过联合乌司他丁能有效降低DKA患者血糖、纠正酸中毒、减轻炎症反应。

Objective： To investigate the effects of hemodiafiltration（ HDF） combined with ulinastatin on blood glucose,acidosis,inflammatory factors and adiponectin in diabetic ketoacidosis（ DKA） patients. Methods A total of 100 cases of DKA hospitalized in our hospital from March 2014 to January 2017 were selected as research objects. All of the patients were randomly assigned into control group and observation group,with 50 patients in each group. All of the patients received conventional therapy after admission. Patients in the control group received HDF treatment on the basis of conventional therapy,and those in the observation group were given HDF and ulinastatin simultaneously. The course of treatment was 2 weeks. Before and after treatment,the fasting blood glucose（ FPG）,glycosylated hemoglobin（ Hb A1 c）,blood lactate（ Lac）,carbon dioxide combining power（ CO2 CP）,p H,urine ketone,adiponectin（ APN）,C reactive protein（ CRP） and tumor necrosis factor-α（ TNF-α） in two groups were detected and compared. Results： After treatment,the levels of FBG,Hb A1 c and Lac in the observation group decreased more obviously than in the control group（ P〈0. 05）.The levels of CO2 CP in both groups increased（ P〈0. 05）,and the p H value returned to normal（ P〈0. 05）. As compared with the control group,turning-to-negative time of urinary keton and p H recovery time in the observation group were significantly shortened（ P〈0. 05）. After treatment,the levels of CRP and TNF-α in both groups were increased（ P〈0. 05）,but those of APN in both groups were decreased（ P〈0. 05）. The level of APN in the observation group was higher than that in the control group（ P〈0. 05）,and the levels of CRP and TNF-α were lower than those in the control group（ P〈0. 05）. Conclusion： Hemodialysis combined with ulinastatin can effectively reduce blood sugar,correct acidosis and alleviate inflammatory reaction.