多模式组合透析对慢性肾功能衰竭患者铁调素、骨硬化蛋白、N末端脑钠肽前体的影响

Effects of multimodal combined dialysis on serum ferritin,osteosclerosis protein and N-terminal pro-brain natriuretic peptide in patients with chronic renal failure

目的观察多模式组合透析对慢性肾功能衰竭患者铁调素、骨硬化蛋白、N末端脑钠肽前体(NT-proBNP)的影响。方法2016年5月—2018年4月石家庄市第一医院肾内科维持性血液透析治疗慢性肾功能衰竭患者210例,按照透析方法不同分为血液透析组(HD)、HD+血液过滤组(HF)、HD+HF+血液灌流组(HP),每组70例。治疗前及治疗12个月后,采用酶联免疫吸附法(ELISA)检测患者血清铁调素、骨硬化蛋白、NT-proBNP水平,并观察比较肾功能(BUN、SCr、24hUP)、血液指标(Alb、Hb、RBC)水平变化情况。结果治疗后,3组患者血清铁调素、骨硬化蛋白、NT-proBNP水平均明显降低(P均<0.01),且降低幅度HD组<HD+HF组<HD+HF+HP组(F/P=44.010/<0.001、101.570/<0.001、3022.69/<0.001);3组患者肾功能指标BUN、SCr、24hUP较治疗前均明显降低(P均<0.01),且降低幅度HD组<HD+HF组<HD+HF+HP组(F/P=9.640/<0.001、8.090/<0.001、65.080/<0.001);3组血清Alb水平均降低,Hb、RBC水平均明显升高(P均<0.01),降低/升高幅度HD组<HD+HF组<HD+HF+HP组(F/P=66.830/<0.001、19.250/<0.001、28.960/<0.001);1年生存率HD组与HD+HF组患者均为97.14%、HD+HF+HP组为98.57%,3组比较差异无统计学意义(P>0.05);并发症发生率HD组为15.71%,HD+HF组为8.57%,HD+HF+HP组为2.85%,3组比较差异有统计学意义(χ^2=7.060,P=0.029)。结论接受维持性血液透析的慢性肾功能衰竭患者应用多模式组合透析能够明显使患者体内血清铁调素、NT-proBNP、骨硬化蛋白水平降低,有效改善患者肾功能、血液指标水平,促进患者康复。

Objective To observe the effects of multimodal combined dialysis on serum ferritin,osteosclerosis protein and N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with chronic renal failure.Methods From May 2016 to April 2018,210 patients with chronic renal failure were divided into hemodialysis group(HD),HD+hemofiltration group(HF),HD+HF+hemoperfusion group(HP)according to different dialysis methods,with 70 cases in each group.Before treatment and 12 months after treatment,serum levels of ferritin,osteosclerosis protein,and NT proBNP were detected by ELISA,and changes of renal function(BUN,SCr,24 h UP),blood parameters(Alb,Hb,RBC)were observed and compared.Results After treatment,the levels of serum ferritin,osteosclerosis protein and NT proBNP in the three groups were significantly decreased(all P<0.01),and the extent of reduction in HD group<HD+HF group<HD+HF+HP group(F/P=44.010/<0.001,101.570/<0.001,3 022.69/<0.001);the renal function indexes BUN,SCr and 24 h UP in the three groups were significantly decreased(all P<0.01).The levels of serum Alb and Hb and RBC in the three groups decreased significantly(P<0.01),while the levels of serum Alb and RBC in the three groups increased significantly(P<0.01).The range of decrease/increase in the HD group<HD+HF group<HD+HF+HP group<HD group<HD+HF group<HD+HP group(F/P=66.830/<0.001,19.250/<0.001,28.960/<0.001)was lower than that in the HD+HF group(F/P=66.830/<0.001,19.250/<0.001,28.960/<0.001).The incidence of complications was 15.71%in the HD group,8.57%in HD+HF group and 2.85%in HD+HF+HP group.There was a significant difference between the three groups(χ^2=7.060,P=0.029).Conclusion Multimodal combined dialysis can significantly reduce the levels of serum ferritin,NT-proBNP and osteosclerosis protein in patients with chronic renal failure receiving maintenance hemodialysis,effectively improve the renal function and blood index level of patients,and promote the rehabilitation of patients.