摘要
目的观察不同血液透析模式对尿毒症维持性血液透析(MHD)患者体内生长因子-15(GDF15)及左心功能的影响.方法选择2017年6月至2018年6月在贵阳市第二人民医院就诊的MHD>3个月的慢性肾衰竭尿毒症患者120例.将患者按透析方式不同分为血液透析(HD)+血液滤过(HDF)+血液灌流(HP)组(每个月进行8次HD、每个月进行4次HDF、每个月进行1次HP)、HD+HDF组(每个月进行8次HD、每个月进行1次HDF)和HD组(每个月进行8次HD),每组40例.治疗前和治疗后6个月、1年采集患者静脉血,检测3组患者血清GDF-15水平;采用超声心动图检测3组患者左心室舒张期末内径(LVDD)、左心室收缩期末内径(LVDS)、左心室舒张期末容积(LVVD)、左心室收缩期末容积(LVVS)、左心室后壁厚度(LVPWT)、室间隔厚度(LVST)、舒张早期及晚期最大血流比(E/A)、左室射血分数(LVEF).结果治疗后,3组患者GDF-15水平及LVDD、LVDS、LVVD、LVVS、LVPWT、LVST、E/A均较治疗前明显降低,LVEF较治疗前明显升高(均P<0.05);且HD+HDF+HP组治疗1年后的变化较HD+HDF组和HD组更显著〔GDF-15(ng):853.78±78.80比921.73±72.54、971.07±72.05,LVDD(mm):48.25±1.25比50.67±1.26、51.69±1.33,LVDS(mm):35.21±1.01比37.84±0.90、38.91±0.83,LVVD(mL):101.44±4.40比109.27±6.47、115.11±5.46,LVVS(mL):35.75±1.52比37.75±1.70、39.48±1.48,LVPWT(mm):8.26±0.77比10.24±0.98、11.22±0.91,LVST(mm):9.07±0.48比10.47±0.61、11.60±0.58,E/A:1.03±0.05比1.07±0.06、1.15±0.08,LVEF:0.64±0.03比0.59±0.03、0.51±0.04,均P<0.05〕.结论不同透析模式组合能有效降低患者体内GDF-15水平,改善MHD患者左心功能,从而能减少心血管事件发生率.
Objective To study the effects of different hemodialysis modes on growth factor-15(GDF-15)and left ventricular function in uremic patients undergoing maintenance hemodialysis(MHD).Methods One hundred and twenty uremic patients with chronic renal failure whose MHD>3 months admitted to Guiyang Second People's Hospital from June 2017 to June 2018 were enrolled,and they were divided into a hemodialysis(HD)+hemofiltration(HDF)+hemoperfusion(HP)group(HD 8 times per month,HDF 4 times per month,HP 1 time per month),a HD+HDF group(HD 8 times per month,HDF 1 time per month)and a HD group(HD 8 times a month)according to different dialysis modes,each group 40 cases.The patients'venous blood was collected before treatment and 6 months and 1 year after treatment,serum was separated,and the GDF-15 levels in the three groups were detected;the left ventricular end-diastolic dimension(LVDD),left ventricular end-systolic dimension(LVDS),left ventricular end-diastolic volume(LVVD),left ventricular end-systolic volume(LVVS),left ventricular posterior wall thickness(LVPWT),ventricular septal thickness(LVST),maximum blood flow ratio(E/A)of early to late diastole and left ventricular ejection fraction(LVEF)in three groups were detected by echocardiography.Results After treatment,the GDF-15 levels and LVDD,LVDS,LVVD,LVVS,LVPWT,LVST and E/A in the three groups were significantly lower than those before treatment,while LVEF was significantly higher than that before treatment(all P<0.05);the changes after treatment in the HD+HDF+HP group were more significant than those in the HD+HDF group and HD group[GDF-15(ng):853.78±78.80 vs.921.73±72.54,971.07±72.05,LVDD(mm):48.25±1.25 vs.50.67±1.26,51.69±1.33,LVDS(mm):35.21±1.01 vs.37.84±0.90,38.91±0.83,LVVD(mL):101.44±4.40 vs.109.27±6.47,115.11±5.46,LVVS(mL):35.75±1.52 vs.37.75±1.70,39.48±1.48,LVPWT(mm):8.26±0.77 vs.10.24±0.98,11.22±0.91,LVST(mm):9.07±0.48 vs.10.47±0.61,11.60±0.58,E/A:1.03±0.05 vs.1.07±0.06,1.15±0.08,LVEF:0.64±0.03 vs.0.59±0.03,0.51±0.04,all P<0.05].Conclusion The combined hemo-dialysis with different hemodialysis modes can effectively reduce the level of GDF-15 in uremic patients with chronic renal failure and MHD and improve their left ventricular function,thus the incidence of cardiovascular events and mortality in such patients can be decreased.
作者
邓晓风
唐玲
万莉
代青
周莹
唐贵文
Deng Xiaofeng;Tang Ling;Wan Li;Dai Qing;Zhou Ying;Tang Guiwen(Department of Nephropathy and Rheumatism,the Second People's Hospital of Guiyang,Guiyang 550081,Guizhou,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第4期409-411,共3页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
贵阳市科技计划项目,筑科合同[2017]01号.
关键词
不同透析模式组合透析
生长因子-15
左心功能
Combined hemodialysis with different hemodialysis modes
Growth factor-15
Left cardiac function