血液透析联合血液灌流对糖尿病肾病维持性血液透析患者血清VEGF、sVCAM-1水平的影响

The Effect of Hemodialysis Combined with Hemoperfusion on Serum VEGF and s VCAM-1 Levels in Patients with Diabetic Nephropathy and Maintenance Hemodialysis

目的讨论血液透析联合血液灌流对糖尿病肾病维持性血液透析患者血清VEGF(血管内皮生长因子)、sVCAM-1(可溶性细胞黏附分子)水平的影响。方法选取2019年1月—2020年12月该院收治的40例糖尿病肾病维持性血液透析患者,随机分为对照组(血液透析)与研究组(血液透析联合血液灌流),各20例。分析并比较两组血清VEGF、sVCAM-1水平,肾功能及血清VEGF、sVCAM-1水平与肾功能之间的关系。结果治疗前组间血清VEGF、sVCAM-1水平比较,差异无统计学意义(P>0.05);治疗2、4、6个月后组间血清VEGF、sVCAM-1水平均降低,且研究组VEGF(150.53±10.55)、(132.47±10.24)、(102.19±12.52)ng/L,s VCAM-1(549.91±53.33)、(539.89±67.21)、(527.33±40.11)μg/L明显优于对照组(161.37±16.92)ng/L、(156.93±11.50)ng/L、(135.68±12.53)ng/L、(636.14±92.45)μg/L、(605.24±90.16)μg/L、(554.79±45.49)μg/L,差异有统计学意义(t=2.109、7.103、8.455、3.613、2.598、2.024,P<0.05)。治疗前组间肾功能指标比较,差异无统计学意义(P>0.05);治疗2、4、6个月后组间尿素氮、肌酐、白蛋白、血β2微球蛋白均降低,且研究组尿素氮(19.47±5.37)、(15.98±4.95)、(15.22±4.84)mmol/L,肌酐(760.64±79.64)、(752.75±73.74)、(715.75±68.47)mol/L,白蛋白(36.62±3.11)、(40.82±3.82)、(44.26±4.31)g/L,血β2微球蛋白(64.99±9.33)、(54.46±9.57)、(50.66±7.72)mg/L明显优于对照组(22.52±6.37)mmol/L、(19.74±6.85)mmol/L、(18.36±4.33)mmol/L、(820.67±92.54)mol/L、(809.85±99.64)mol/L、(805.63±82.89)mol/L、(36.24±3.22)g/L、(39.92±4.23)g/L、(41.24±3.99)g/L、(72.57±10.11)mg/L、(66.43±10.02)mg/L、(61.34±9.99)mg/L,差异有统计学意义(P<0.05),且组间白蛋白指标均升高,但研究组升高水平明显优于对照组,差异有统计学意义(P<0.05)。Spearman秩相关分析结果:VEGF与尿素氮、肌酐、血β2微球蛋白呈正相关关系,sVCAM-1与肌酐、血β2微球蛋白呈正相关关系。尿素氮与肌酐呈正相关关系(r=0.382,P<0.05),与白蛋白呈负相关关系(r=-0.394,P<0.05);肌酐与白蛋白呈负相关关系(r=-0.398,P<0.05);血β2微球蛋白与白蛋白呈负相关关系(r=-0.378,P<0.05)。结论对糖尿病肾病维持性血液透析患者采取血液透析联合血液灌流治疗方案后,可有效降低其血清VEGF、sVCAM-1水平,改善肾功能,且血清VEGF、sVCAM-1水平可有效反映患者肾功能,可作为评估患者病情的有效依据。

Objective To discuss the effect of hemodialysis combined with hemoperfusion on serum VEGF(vascular endothelial growth factor) and sVCAM-1(soluble cell adhesion molecule) levels in patients with diabetic nephropathy and maintenance hemodialysis. Methods From January 2019 to December 2020, 40 patients with diabetic nephropathy undergoing maintenance hemodialysis were selected and randomly divided into the control group(hemodialysis) and the study group(hemodialysis combined with hemoperfusion), each with 20 cases. Analyzed and compared serum VEGF, sVCAM-1 levels, renal function and the relationship between serum VEGF, sVCAM-1 levels and renal function. Results There was no statistically significant difference in serum VEGF and sVCAM-1 levels between groups before treatment(P>0.05);serum VEGF and sVCAM-1 levels decreased between groups after 2, 4, and 6 months of treatment, and the study group VEGF(150.53±10.55)ng/L,(132.47 ±10.24)ng/L,(102.19 ±12.52)ng/L, sVCAM-1(549.91 ±53.33)μg/L,(539.89 ±67.21)μg/L,(527.33 ±40.11)μg/L were significantly better than the control group(161.37±16.92)ng/L,(156.93±11.50)ng/L,(135.68±12.53)ng/L,(636.14±92.45)μg/L,(605.24±90.16)μg/L,(554.79±45.49)μg/L, the difference was statistically significant(t=2.109, 7.103, 8.455, 3.613, 2.598, 2.024,P<0.05). There was no statistically significant difference in renal function indexes between the groups before treatment(P>0.05);after 2, 4, and 6 months of treatment, urea nitrogen, creatinine, albumin, and blood β2 microglobulin were all decreased, and the study group urea nitrogen(19.47 ±5.37)mmol/L,(15.98 ±4.95)mmol/L,(15.22 ±4.84)mmol/L, creatinine(760.64 ±79.64)mol/L,(752.75±73.74)mol/L,(715.75±68.47)mol/L, albumin(36.62±3.11) g/L,(40.82±3.82)g/L,(44.26±4.31)g/L, blood β2 microglobulin(64.99 ±9.33)mg/L,(54.46 ±9.57)mg/L and(50.66 ±7.72)mg/L were significantly better than the control group(22.52 ±6.37)mmol/L,(19.74±6.85)mmol/L,(18.36±4.33)mmol/L,(820.67±92.54)mol/L,(809.85±99.64)mol/L、(805.63±82.89)mol/L,(36.24±3.22)g/L,(39.92±4.23)g/L,(41.24±3.99)g/L,(72.57±10.11)mg/L,(66.43±10.02)mg/L,(61.34±9.99)mg/L, the difference was statistically significant(P<0.05), and the albumin indexes between the groups were all increased, but the increase level of the study group was significantly better than the control group, the difference was statistically significant(P<0.05). Spearman rank correlation analysis results: VEGF was positively correlated with urea nitrogen, creatinine, and blood β2 microglobulin,and sVCAM-1 was positively correlated with creatinine and blood β2 microglobulin. Urea nitrogen was positively correlated with creatinine(r=0.382, P<0.05), and negatively correlated with albumin(r=-0.394, P<0.05);creatinine was negatively correlated with albumin(r=-0.398, P<0.05);there was a negative correlation between blood β2 microglobulin and albumin(r =-0.378, P <0.05). Conclusion The treatment of hemodialysis combined with hemoperfusion for patients with diabetic nephropathy on maintenance hemodialysis can effectively reduce their serum VEGF and sVCAM-1 levels and improve renal function, and serum VEGF and sVCAM-1 levels can effectively reflect the patient’s renal function, can be used as an effective basis for evaluating the patient’s condition.