血液透析结合血液灌注疗法对改善慢性肾脏病患者矿物质骨代谢肾功能炎性指标及不良反应的临床研究

Clinical efficacy of hemodialysis combined with hemoperfusion in improving minerals bone metabolism renal function inflammatory indicators and adverse reactions in patients with chronic kidney disease

目的探讨血液透析联合血液灌注对慢性肾脏病患者的治疗效果及不良反应情况。方法选取长治市第二人民医院2018年5月至2021年5月收治的92例慢性肾脏病患者进行研究,并将患者按随机数字表法分为观察组46例与对照组46例。给予对照组患者单纯血液透析治疗,给予观察组血液透析联合血液灌注治疗,对比2组患者治疗前后炎症因子水平,血清甲状腺旁素,钙、磷水平,肾功能与骨代谢指标以及不良反应发生情况。结果治疗后2组患者白细胞介素(IL)-6、IL-1、肿瘤坏死因子-α(TNF-α)水平均降低,且观察组低于对照组(P<0.05);治疗后2组患者血清甲状腺旁素(iPTH)、血磷水平均降低,观察组低于对照组(P<0.05);治疗后2组患者尿白蛋白排泄率(UAER)、β2-微球蛋白(β2-MG)、抗酒石酸酸性磷酸酶5b(TRAP-5b)水平明显降低,且观察组低于对照组,内生肌酐清除率(Ccr)、1型胶原羧基端交联端肽(CTx)水平明显升高,观察组高于对照组(P<0.05);2组患者不良反应发生率对比差异无统计学意义(P>0.05)。结论血液透析结合血液灌注疗法能够改善慢性肾脏病患者的炎症反应、矿物质、肾功能以及骨代谢,安全性好,值得临床应用推广。

Objective To investigate the treatment efficacy and adverse effects of hemodialysis combined with hemoperfusion in patients with chronic kidney disease.Methods A total of 92 patients with chronic kidney disease admitted to Changzhi second people′s hospital between May 2018 and May 2021 were included in this study and randomly divided into the study group(n=46)and control group(n=46)with equal patient number.The control group underwent hemodialysis alone,while the study group underwent hemodialysis combined with hemop-erfusion.The two groups were compared for the levels of inflammatory factors,serum parathyroid hormone,calci-um,and phosphorus levels,renal function,bone metabolism,and adverse reactions before and after the treatment.Results After treatment,the levels of interleukin-6(IL-6),interleukin-1(IL-1)and tumor necrosis factor-α(TNF-α)in the two groups of patients decreased,and these levels were lower in the study group compared with the control group(P<0.05).After treatment,the serum levels of intact parathyroid hormone(iPTH)and phosphorus decreased in the two groups of patients,and these levels were lower in the study group compared with the control group(P<0.05).After treatment,the urinary albumin excretion rate(UAER),Β2-microglobulin(β2-MG)and tartrate-resistant acid phosphatase 5b(TRAP-5b)levels were significantly reduced,and these values were lower in the study group compared with the control group;the endogenous creatinine clearance rate(Ccr)and level of cross-linked carboxy-terminal telopeptide of type 1 collagen(CTx)were significantly increased,and these values were higher in the study group compared with the control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion Hemodialysis combined with hemoperfusion can im-prove the inflammatory response,minerals,renal function and bone metabolism in patients with chronic kidney disease,with good safety that justifies its widespread use in clinical setting.