血液透析联合血液灌流与单纯血液透析滤过在慢性肾脏病患者中的应用效果比较

Comparison of the effects of hemodialysis combined with hemoperfusion and simple hemodiafiltration in patients with chronic renal disease

目的比较血液透析联合血液灌流与单纯血液透析滤过在慢性肾脏病(chronic kidney disease,CKD)患者中的应用效果。方法选取2016年6月至2018年6月重庆医科大学第二附属医院收治的62例CKD患者为研究对象,按照随机数字表法将其分为联合组和对照组,每组各31例。联合组患者采取血液透析联合血液灌流治疗,对照组患者采取单纯血液透析滤过治疗。比较两组患者治疗4周和8周后血清C反应蛋白(C reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor,TNF-α)、降钙素原(procallcitonin,PCT)、同型半胱氨酸(homocysteine,Hcy)、β2微球蛋白(β2-microgiobulin,β2M)、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、钙、磷水平和治疗6个月后的左心室功能。结果治疗4周和8周后,两组患者血清CRP、TNF-α、PCT、Hcy、β2M、iPTH、血钙、血磷水平均显著低于本组治疗前(均P<0.05),且联合组患者血清CRP、TNF-α、PCT、Hcy、β2M、iPTH水平均显著低于同期对照组(均P<0.05)。治疗6个月后,联合组患者左心室舒张末内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)和左心室质量指数(left ventricular mass index,VLMI)均显著小于本组治疗前(均P<0.05),对照组患者上述指标与治疗前比较差异均无统计学意义(均P>0.05),联合组患者治疗6个月后LVESD、LVPWT和VLMI均显著小于同期对照组(均P<0.05)。结论与单纯血液透析治疗相比,血液透析联合血液灌流能有效清除血清炎性物质及大分子毒素,有效纠正钙磷代谢失衡,缓解左心室肥厚。

Objective To compare the effect of hemodialysis combined with hemoperfusion and simple hemodiafiltration in patients with chronic kidney disease(CKD).Method A total of 62 patients with CKD admitted to the Second Affiliated Hospital of Chongqing Medical University from June 2016 to June 2018 were selected as the research subjects,and they were divided into combination group and control group according to the random number table method,with 31 cases in each group.Patients in combination group were treated with hemodialysis combined with hemoperfusion,patients in control group were treated with simple hemodiafiltration.The levels of serum C reactive protein(CRP),tumor necrosis factor-α(TNF-α),procallcitonin(PCT),homocysteine(Hcy),β2-microgiobulin(β2M),intact parathyroid hormone(iPTH),calcium and phosphorus after 4 weeks and 8 weeks of treatment and left ventricular function after 6 months of treatment were compared between the two groups.Result After 4 weeks and 8 weeks of treatment,the levels of serum CRP,TNF-α,PCT,Hcy,β2M,iPTH,calcium and phosphorus in the two groups were significantly lower than those before treatment(all P<0.05),and the levels of serum CRP,TNF-α,PCT,Hcy,β2M and iPTH in combination group were significantly lower than those in control group during the same time period(all P<0.05).After 6 months of treatment,the left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular posterior wall thickness(LVPWT)and left ventricular mass index(VLMI)in combination group were significantly lower than those before treatment(all P<0.05),and there were no significant differences in the above indexes in control group compared with those before treatment(all P>0.05),the LVESD,LVPWT and VLMI in combination group were significantly lower than those in control group after 6 months of treatment(all P<0.05).Conclusion Compared with simple hemodiafiltration,hemodialysis combined with hemoperfusion can effectively remove serum inflammatory substances and macromolecular toxins,effectively correct the imbalance of calciumphosphorus metabolism,and alleviate left ventricular hypertrophy.