不同血液透析模式对尿毒症维持性血液透析患者生长因子-15水平及左心功能的影响

Effects of different hemodialysis modes on level of growth factor-15 and left heart function in uremia patients undergoing maintenance hemodialysis

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.