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VEGF、sVCAM-1水平的影响

Effect of Hemodialysis Combined with Hemoperfusion on Serum Levels of VEGF and sVCAM-1 in Patients with Diabetic Nephropathy Undergoing 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)患者血清血管内皮生长因子(VEGF)、可溶性细胞黏附分子(sVCAM-1)的影响,并分析其临床意义。方法选取2015年1月—2018年1月定期于该院血液透析中心进行MHD的80例DN患者,根据随机、双盲的分组方法,将患者分为HD组(40例)和HD+HP组(40例),检测患者治疗前(M0)及治疗后3、6个月血浆VEGF、sVCAM-1和相关指标(BUN、Scr、ALb)的变化,分析VEGF、sVCAM-1与DN的相关性。结果 HD+HP组治疗后BUN、Scr均显著下降,ALb显著增高(P<0.05),HD+HP组BUN、Scr、ALb指标优于HD组(P<0.05);HD组和HD+HP组治疗后VEGF、sVCAM-1水平均显著降低(P<0.05),比较各时间点组间治疗后的指标,与HD组相比较,HD+HP组sVCAM-1、VEGF明显较低(P<0.05);sVCAM-1与Scr、BUN呈正相关;VEGF与BUN、Scr呈正相关;ALb与Scr呈负相关(r=-0.397,P=0.000);BUN与ALb呈负相关(r=-0.394,P=0.000),与Scr呈正相关(r=0.381,P=0.000)。结论联合HD+HP治疗可显著降低DN患者的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;VEGF、sVCAM-1水平可作为DN患者病情监测和预后的指标。

Objective To investigate the role of hemodialysis(HD) combined with hemoperfusion(HP) in serum vascular endothelial growth factor(VEGF) and soluble cell adhesion molecule(sVCAM-1) in patients with diabetic nephropathy(DN) maintenance hemodialysis(MHD) influence and analyze its clinical significance. Methods Eighty patients with DN who underwent MHD at our Hemodialysis Center from January 2015 to January 2018 were enrolled. Patients were divided into HD group(40 cases) and HD+HP group(40 cases) according to a randomized, double-blind grouping method. The changes of plasma VEGF, sVCAM-1 and related indicators(BUN, Scr, ALb) were measured before treatment(M0) and 3 months and 6 months after treatment, and VEGF, sVCAM-1 and DN were analyzed. Results After treatment with HD+HP, BUN and Scr decreased significantly, and ALb increased significantly(P<0.05). HD+HP group had better BUN, Scr, and ALb indexes than HD group(P<0.05);HD group and HD+HP group after treatment, the levels of VEGF and sVCAM-1 were significantly decreased(P<0.05). The indexes of treatment were compared between the groups at each time point. Compared with HD group, sVCAM-1 and VEGF were significantly lower in HD +HP group(P<0.05);sVCAM-1 was positively correlated with Scr and BUN;VEGF was positively correlated with BUN and Scr;ALb was negatively correlated with Scr(r=-0.397, P=0.000);BUN was negatively correlated with ALb(r=-0.394, P =0.000), positively correlated with Scr(r=0.381, P=0.000). Conclusion Combined with HD+HP treatment can significantly reduce the levels of VEGF and sVCAM-1 in DN patients, protect renal function, and is more suitable for patients with DN who have long-term hemodialysis. VEGF and sVCAM-1 levels can be used as indicators for disease monitoring and prognosis of DN patients.