不同血液净化方式对尿毒症患者血清Fetuin-A及Apelin表达的影响

Effects of different blood purification methods on serum fetuin A and apelin levels in uremic patients

目的探讨不同血液净化方式对尿毒症患者血清胎球蛋白A(Fetuin-A)及脂肪因子(Apelin)表达的影响。方法选择承德市中心医院肾内科2017年2月~2019年2月收治的114例尿毒症患者,随机数字表法分为高通量血液透析(high throughput hemodialysis,HFHD)组、血液透析滤过(hemodiafiltration,HDF)组、血液透析联合血液灌流(hemodialysis and hemoperfusion,HD+HP)组,每组38例,治疗后,比较3组患者血清Fetuin-A、Apelin、尿素氮(urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)、Kt/V、血磷、血钙、钙磷乘积、血清β_(2)-微球蛋白(β_(2)-microglobulin,β_(2)-MG)、甲状旁腺素(parathyroid hormone,PTH)水平以及治疗总有效率。结果治疗后HD+HP组Fetuin-A水平显著高于HFHD组并高于HDF组(F=48.814,P<0.001),Apelin水平显著低于HFHD组并低于HDF组(F=8.578,P<0.001);HD+HP组BUN水平低于HFHD组和HDF组(F=3.001,P=0.053),Scr水平高于HFHD组和HDF组(F=1.206,P=0.303),3组Kt/V指标比较差异不明显(F=1.942,P=0.148);治疗后3组患者血磷、钙磷乘积比较差异显著(F值分别为14.144,11.590;P值分别为<0.001,<0.001),3组血钙水平无显著差异(F=0.045,P=0.956);HD+HP组β_(2)-MG水平显著低于HFHD组并低于HDF组(F=355.820,P<0.001),PTH水平显著低于HFHD组并低于HDF组(F=182.270,P<0.001);HD+HP组总有效率为92.11%,HFHD组总有效率为89.47%,HDF组总有效率为63.16%,3组间比较差异显著(χ^(2)=34.100,P<0.001)。结论HD+HP、HFHD以及HDF治疗尿毒症患者均展现出较好的治疗效果,能够提高血清Fetuin-A水平并降低Apelin水平,但HD+HP血液透析效果较好,HFHD位列其次,而HDF稍弱。

Objective To investigate the effects of different blood purification methods on serum fetuin A and apelin levels in uremic patients.Methods A total of 114 of uremic patients admitted to Chengde Central Hospital from February 2017 to February 2019 were recruited as the research subjects.They were assigned into high throughput hemodialysis(HFHD,n=38),hemodiafiltration(HDF,n=38),and hemodialysis plus hemoperfusion(HD+HP,n=38)by the random number list method.After the treatment,serum fetuin A and apelin,urea nitrogen(BUN),serum creatinine(Scr),Kt/V,serum phosphorus and calcium,calcium-phosphorus product,β_(2)-microglobulin(β_(2)-MG)and parathyroid gland(PTH)levels,and overall therapeutic efficiency were compared among the three groups.Results After the treatment,serum fetuin A was significantly higher(F=48.814,P<0.001)and serum apelin was significantly lower(F=8.578,P<0.001)in HD+HP group than in HFHD group and HDF group;BUN was lower(F=3.001,P=0.053)and Scr was higher(F=1.206,P=0.303)in HD+HP group than in HFHD group and HDF group.There were no significant differences in Kt/V index among the three groups(F=1.942,P=0.148).After the treatment,serum phosphorus and phosphorus-calcium product were significantly different among the three groups(serum phosphorus:F=14.144,P=0.000;calcium-phosphorus product:F=11.590,P=0.000),but there were no significant differences in serum calcium level among the three groups(F=0.045,P=0.956);serumβ_(2)-MG and PTH were significantly lower in HD+HP group than in HFHD group and HDF group(F=355.820,P<0.001;F=182.270,P<0.001).The overall effective rates were 92.11%,89.47%and 63.16%in HD+HP group,HFHD group and HDF group respectively(χ^(2)=34.100,P<0.001).Conclusion Uremic patients treated with either HD+HP,HFHD or HDF showed better effects,with the increase of serum fetuin A and decrease of serum apelin.HD+HP had the best blood purification effects,followed by HFHD and HDF methods.