高通量血液透析对2型糖尿病肾病患者毒素清除和炎症因子、氧化应激因子水平的影响

Effects of High-flux Hemodialysis on Toxin Clearance and Levels of Inflammatory Factors and Oxidative Stress Factors in Patients with Type 2 Diabetic Nephropathy

目的探究高通量血液透析(HFHD)对2型糖尿病肾病(DN)患者毒素清除和炎症因子、氧化应激因子水平的影响。方法采用计算机随机数字法将2016年1月至2018年1月我院收治的96例DN患者分为观察组和对照组各48例。观察组患者予以HFHD治疗,对照组患者予以低通量血液透析(LFHD)治疗。比较两组患者血清小分子毒素[血肌酐(SCr)、血尿素、血尿酸、血磷]、中分子及大分子毒素[甲状旁腺素(PTH)、视黄醇结合蛋白(RBP)、血清β_2微球蛋白(β_2-MG)、半胱氨酸蛋白酶抑制剂(CysC)]清除效果,观察治疗前、治疗6个月后血清炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]、氧化应激因子[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]水平变化情况。结果治疗6个月后,两组患者SCr、血尿素、血尿酸、血磷以及血清PTH、RBP、β_2-MG、CysC水平均较治疗前降低(P<0. 05),且观察组血尿酸、血磷以及血清PTH、RBP、β_2-MG、CysC水平均低于对照组(P<0.05);观察组患者血清IL-6、CRP、TNF-α、MDA水平均较治疗前降低,且低于对照组(P <0. 05),SOD、GSH-Px水平较治疗前升高,且高于对照组(P <0. 05),对照组患者治疗前后上述指标比较,差异无统计学意义(P>0.05)。结论 HFHD可有效清除DN患者血液中的毒素,减轻机体炎症反应并改善氧化应激水平。

Objective To explore the effects of high-flux hemodialysis(HFHD) on toxin clearance and levels of inflammatory factors and oxidative stress factors in patients with type 2 diabetic nephropathy(DN).Methods 96 cases of patients with DN admitted to our hospital from January,2016 to January,2018 were divided into the observation group and the control group by random number method,with 48 cases in each group.The observation group was given HFHD,and the control group was given low-flux hemodialysis(LFHD).The clearance effects of serum micromolecule toxins [serum creatinine(SCr),blood urea,blood uric acid,blood phosphorus],medium molecular and macromolecular toxins [parathyroid hormone(PTH),retinol binding protein(RBP),serum β 2 microglobulin(β 2 -MG) and cysteine proteinase inhibitors(CysC)] were compared between the two groups.The levels of serum inflammatory factors [interleukin-6(IL-6),C-reaction protein(CRP),tumor necrosis factor-α(TNF-α)] and oxidative stress factors [malondialdehyde(MDA),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)] were observed before treatment and after 6 months of treatment.Results After 6 months of treatment,the levels of SCr,blood urea,blood uric acid,blood phosphorus and serum PTH,RBP,β 2 -MG and CysC in the two groups were lower than those of pre-treatment(P <0.05),and the levels of blood uric acid,blood phosphorus,and serum PTH,RBP,β 2 -MG and CysC in the observation group were lower than those in the control group(P <0.05).The levels of serum IL-6,CRP,TNF-α and MDA in the observation group were lower than those of pre-treatment,and were lower than those in the control group(P <0.05),and the levels of SOD and GSH-Px were higher than those of pre-treatment,and were higher than those in the control group(P <0.05).There were no significant differences among the above indexes in the control group before and after treatment(P >0.05).Conclusion HFHD can effectively remove toxins from the blood of DN patients,reduce the body’ s inflammatory response and improve the oxidative stress level.