高通量血液透析与低通量血液透析在尿毒症患者中的应用效果

Efficacy of High-Flux Hemodialysis and Low-Flux Hemodialysis in Uremia Patients

目的比较高通量血液透析与低通量血液透析在尿毒症患者中的应用效果。方法选取2017年2月至2019年6月在延津县人民医院接受治疗的尿毒症患者共78例。根据治疗方案分为低通量组(n=39)和高通量组(n=39)。低通量组采用低通量血液透析治疗,高通量组采用高通量血液透析治疗。比较两组临床疗效以及治疗前、治疗6个月血清肌酐(Scr)、β_(2)-微球蛋白(β_(2)-MG)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、每分心输出量(CO)、左室射血分数(LVEF)、白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)水平。结果高通量组临床总有效率高于低通量组(P<0.05)。治疗6个月,两组Scr、β_(2)-MG、FINS、HOMA-IR、IL-6、hs-CRP、TNF-α、cTnT、CK-MB水平低于治疗前,高通量组Scr、β_(2)-MG、FINS、HOMA-IR、IL-6、hs-CRP、TNF-α、cTnT、CK-MB水平低于低通量组(P<0.05)。治疗6个月,两组LVEF、CO高于治疗前,高通量组LVEF、CO高于低通量组(P<0.05)。结论与低通量血液透析相比,将高通量血液透析应用于尿毒症患者的疗效显著,可降低血清心肌损伤标志物水平,减轻微炎症状态及胰岛素抵抗,改善肾功能及心功能。

Objective To compare the application effects of high-flux hemodialysis and low-flux hemodialysis in uremia patients.Methods A total of 78 uremia patients who were treated in Yanjin County People’s Hospital from February 2017 to June 2019 were selected.According to the treatment plan,the patients were divided into low-flux group(n=39)and high-flux group(n=39).The low-flux group was treated with low-flux hemodialysis,and the high-flux group was treated with high-flux hemodialysis.The clinical efficacy,serum creatinine(Scr),β_(2)-microglobulin(β_(2)-MG),fasting insulin(FINS),homeostasis model assessment-insulin resistance index(HOMA-IR),minute cardiac output(CO),left ventricular ejection fraction(LVEF),interleukin-6(IL-6)and hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),cardiac troponin T(cTnT)and creatine kinase-MB(CK-MB)were compared between the two groups before and after treatment for 6 months.Results The total clinical effective rate of high-flux group was higher than that of low-flux group(P<0.05).After 6 months of treatment,the levels of Scr,β_(2)-MG,FINS,HOMA-IR,IL-6,hs-CRP,TNF-α,cTnT and CK-MB in the two groups were lower than those before treatment,while those in high-flux group were lower than those in low-flux group(P<0.05).After 6 months of treatment,LVEF and CO in the two groups were higher than those before treatment,and those in high-flux group were higher than those in low-flux group(P<0.05).Conclusion Compared with low-flux hemodialysis,the application of high-flux hemodialysis in uremia patients has remarkable curative effect,which can reduce the levels of serum myocardial injury markers,relieve the micro-inflammatory state and insulin resistance,and improve the renal function and cardiac function.