糖尿病肾病引发慢性肾衰竭患者采用骨化三醇、高通量血液透析联合治疗的效果

The Effect of Combined Treatment of Calcitriol and High Flux Hemodialysis in Patients with Chronic Renal Failure Caused by Diabetic Nephropathy

目的研究骨化三醇联合高通量血液透析在糖尿病肾病(DN)引起慢性肾衰竭(CRF)患者中的应用效果。方法选取该院及上海血液透析质量控制中心2018年1月—2021年1月收治的120例DN引起CRF患者,采用随机分组法分为研究组、对照组,各60例。对照组采用骨化三醇联合普通血液透析治疗,研究组采用高通量血液透析、骨化三醇联合治疗。治疗3个月,比较两组钙磷代谢情况及治疗效果。结果治疗前,两组钙磷水平比较,差异无统计学意义(P>0.05),治疗后,两组钙水平明显上升,磷水平明显降低,且研究组钙水平(2.7±0.4)mmol/L高于对照组(2.1±0.2)mmol/L,研究组磷水平(1.5±0.2)mmol/L低于对照组(2.0±0.3)mmol/L,差异有统计学意义(t=10.392、10.742,P<0.05);治疗前,两组肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平比较,差异无统计学意义(P>0.05),治疗后,两组IL-6、TNF-α水平明显降低,且研究组TNF-α(92.6±18.4)pg/mL、IL-6(4.6±0.5)ng/L均低于对照组(115.7±21.6)pg/mL、(7.8±1.2)ng/L,差异有统计学意义(t=6.305、19.070,P<0.05);治疗后两组患者的细胞成纤维生长因子(FGF23)、尿素氮(BUN)、血肌酐(SCr)水平均明显降低,肾小球滤过率(GFR)水平明显升高,且研究组变化幅度均高于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率(8.33%)与对照组(11.67%)比较,差异无统计学意义(χ^(2)=0.370,P>0.05)。结论DN引起CRF患者采用高通量血液透析、骨化三醇联合治疗可改善钙磷代谢水平,抑制炎性反应,保护肾功能。

Objective To study the effect of calcitriol combined with high flux hemodialysis in patients with chronic renal failure(CRF) caused by diabetic nephropathy(DN). Methods A total of 120 DN-caused CRF patients admitted to the hospital and Shanghai Hemodialysis Quality Control Center from January 2018 to January 2021 were selected.Randomized grouping was divided into study group and control group, each with 60 cases. The control group was treated with calcitriol combined with ordinary hemodialysis, and the study group was treated with high-flux hemodialysis and calcitriol. After 3 months of treatment, the calcium and phosphorus metabolism and treatment effects were compared between the two groups. Results Before treatment, there was no statistically significant difference in the levels of calcium and phosphorus between the two groups(P>0.05). After treatment, the levels of calcium and phosphorus in the two groups increased significantly, while the levels of phosphorus decreased significantly, and the calcium level of the study group(2.7±0.4) mmol/L was higher than that of the control group(2.1±0.2) mmol/L, the phosphorus level of the study group(1.5±0.2) mmol/L was lower than that of the control group(2.0±0.3) mmol/L, the difference was statistically significant(t=10.392, 10.742, P<0.05). Before treatment, there was no statistically significant difference in the levels of tumor necrosis factor-α(TNF-α) and interleukin 6(IL-6)between the two groups(P >0.05). After treatment, the two groups of IL-6, the level of TNF-α was significantly reduced, and TNF-α(92.6±18.4) pg/mL and IL-6(4.6±0.5) ng/L in the study group were lower than those in the control group(115.7±21.6) pg/mL,(7.8±1.2) ng/L, the difference was statistically significant(t=6.305,19.070, P<0.05).After treatment, the levels of cellular fibroblast growth factor(FGF23), urea nitrogen(BUN), and serum creatinine(SCr) of the two groups of patients were significantly reduced, and the glomerular filtration rate(GFR) levels were significantly increased, the range of changes in the group was higher than that in the control group, the difference was statistically significant(P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the study group(8.33%) and the control group(11.67%)(χ^(2)=0.370, P>0.05). Conclusion DNinduced CRF patients with high-flux hemodialysis and calcitriol combined treatment can improve the level of calcium and phosphorus metabolism, inhibit inflammatory reactions, and protect renal function.