血液透析联合血液灌流对糖尿病肾病维持性血液透析患者血清vWf、VEGF、sVCAM-1水平的影响

Effect of hemodialysis combined with hemoperfusion on serum vWf,VEGF and sVCAM-1 levels in patients with diabetic nephrosis maintenance hemodialysis

目的探讨血液透析(HD)联合血液灌流(HP)对糖尿病肾病(DN)维持性血液透析(MHD)患者血清血管性血友病因子(vWf)、血管内皮生长因子(VEGF)、可溶性细胞黏附分子(sVCAM-1)水平的影响,并分析vWf、VEGF、sVCAM-1的临床意义。方法选取定期接受MHD的DN患者96例,随机双盲分为HD组和HD+HP组,各48例,检测患者治疗前以及治疗后2、4、6个月血浆vWf、VEGF、sVCAM-1和相关指标(BUN、Scr、ALb、β2-MG)的变化,分析其与DN的相关性,Logistic回归分析预测DN不良预后的危险因子。结果 HD+HP组患者治疗后BUN、Scr、β2-MG均出现显著下降(P<0.05),ALb显著增高(P<0.05),HD+HP组BUN、Scr、ALb、β2-MG指标优于HD组(P<0.05);HD组和HD+HP组治疗后vWf、VEGF、sVCAM-1水平均显著下降(P<0.05),治疗后各时点组间比较,HD+HP组vWf、VEGF、sVCAM-1显著低于HD组(P<0.05);vWf、VEGF、sVCAM-1与BUN、Scr、ALb、β2-MG之间存在一定程度相关性,其中vWf与VEGF、sVCAM-1呈正相关,VEGF与BUN、Scr、β2-MG呈正相关;sVCAM-1与BUN、Scr、β2-MG呈正相关,vWf、BUN、Scr、β2-MG均与ALb呈负相关(P<0.05);Logistic分析结果显示vWf>815U/L 3.592(95%CI:2.956~7.261)、VEGF>176ng/L 2.913(95%CI:1.238~5.238)、sVCAM-1>829μg/L 2.619(95%CI:1.538~6.648),是DN不良结局的独立危险因素。结论联合HD+HP治疗可显著降低DN患者的vWf、VEGF、sVCAM-1水平,保护肾功能,更适合长期进行血液透析的DN患者;vWf、VEGF、sVCAM-1水平可作为DN患者病情监测和预后的指标。

Objective To investigate hemoperfusion（HP）combined with hemodialysis（HD）on diabetic nephropathy（DN）in maintenance hemodialysis（MHD）patients with serum von Willebrand factor（vWf）and vascular endothelial growth factor（VEGF）and soluble cell adhesion molecule（sVCAM-1）effect,and analyze the clinical significance of vWf,VEGF,sVCAM-1.Methods Selected from January 2013 to June 2016 regular hemodialysis center96 DN patients received MHD cases in our hospital,according to the method of dialysis randomized double-blind hemodialysis divided into two groups,（HD group）and hemoperfusion group（HD＋HP group）48 cases,DN detected96 cases of maintenance hemodialysis patients before treatment and after treatment 2,4,and 6 months treatment,VEGF,sVCAM-1 and vWf plasma related indicators（BUN,Scr,ALb,β2-MG）variation,correlation analysis of vWf,VEGF,sVCAM-1 and DN,Logistic regression analysis was used to predict the risk factors for poor prognosis of DN.Results HD＋HP group of patients after treatment BUN,Scr andβ2-MG are significantly decreased（P〈0.05）,ALb increased significantly（P〈0.05）,HD＋HP group,BUN Scr,ALb,β2-MG index was better than that of HD group（P〈0.05）.HD group and HD＋HP group after treatment,vWf,VEGF and sVCAM-1 were decreased significantly（P〈0.05）,after the treatment of each point between the 22 groups compared with group vWf,VEGF,HD＋HP and sVCAM-1 were significantly lower in group HD（P〈0.05）.There was a certain degree of correlation between vWf,VEGF,sVCAM-1 and BUN,Scr,ALb,β2-MG,vWf and VEGF,sVCAM-1 was positively related to VEGF with BUN,Scr andβ2-MG was positively correlated with BUN,sVCAM-1.Scr,vWf,β2-MG was positively correlated with BUN,Scr andβ2-MG were negatively correlated with ALb（P〈0.05）.Logistic analysis showed that vWf〉815 U/L 3.592（95%CI：2.956-7.261）,VEGF,176 ng/L 2.913（95% CI：1.238-5.238）SVCAM-1〉829μg/L 2.619（95% CI：1.538-6.648）was an independent risk factor for the adverse outcome of DN.Conclusion Combined HD＋HP treatment can significantly reduce the level of vWf,VEGF and sVCAM-1 in DN patients,protect renal function,and is more suitable for long-term hemodialysis patients with DN.VWf,VEGF and sVCAM-1 levels can be used as monitoring index and prognosis of patients with DN.