血液透析联合血液灌流在维持性血液透析合并脂质代谢异常患者中的应用

Application of hemodialysis combined with hemoperfusion in patients with abnormal lipid metabolism undergoing maintenance hemodialysis

目的 探讨血液透析联合血液灌流在维持性血液透析(MHD)合并脂质代谢异常患者中的应用效果。方法 选取佛山市第五人民医院血液净化中心2021年4月1日至9月31日接诊的60例MHD合并脂代谢异常患者进行研究,根据随机数表法将患者分为对照组和观察组各30例。对照组患者采用血液透析治疗,观察组患者行血液透析联合血液灌流治疗,两组患者的疗程为6个月。比较两组患者治疗前后的总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A (APOA)、载脂蛋白B (APOB)、白细胞计数(WBC)、血红蛋白(HGB)、血小板计数(PLT)、中性粒细胞计数(NEU)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、甲状旁腺激素(PTH)和β2微球蛋白(β2-MG)水平。结果 治疗后,观察组患者的TC、TG、LDL-C、APOA、APOB水平分别为(4.85±0.32) mmol/L、(3.64±0.35) mmol/L、(4.08±0.60) mmol/L、(1.09±0.16) g/L、(0.81±0.07) g/L,明显低于对照组的(5.64±0.67) mmol/L、(5.71±0.33) mmol/L、(3.74±0.65) mmol/L、(1.46±0.20) g/L、(1.25±0.10) g/L,HDL-C水平为(2.00±0.55) mmol/L,明显高于对照组的(1.41±0.42) mmol/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的各项血常规指标比较差异均无统计学意义(P>0.05);治疗后,观察组患者的PT、APTT、TT、FIB、PTH、β2-MG水平分别为(12.17±0.48) s、(26.52±2.16) s、(11.46±0.25) s、(12.23±0.36) g/L、(73.36±5.14) pg/mL、(23.96±2.73)μmol/L,明显低于对照组的(13.69±0.54) s、(29.75±2.08) s、(13.40±0.30) s、(14.80±0.53) g/L、(85.24±7.05) pg/mL、(29.80±3.35)μmol/L,差异均具有统计学意义(P<0.05)。结论 MHD合并脂质代谢异常患者采用血液透析联合血液灌流治疗能有效改善血脂水平、降低凝血功能和PTH水平,值得临床推广应用。

Objective To investigate the effect of hemodialysis combined with hemoperfusion in patients with abnormal lipid metabolism undergoing maintenance hemodialysis(MHD).Methods A total of 60 patients with abnormal lipid metabolism undergoing maintenance hemodialysis admitted in Blood Purification Center,Foshan Fifth People's Hospital from April 1,2021 to September 31,2021 were selected for the study.The patients were divided into a control group and an observation group,with 30 patients in each group,according to random number table method.The control group was treated with hemodialysis,and the observation group was treated with hemodialysis combined with hemoperfusion.The course of treatment for the two groups was 6 months.The total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein(LDL-C),apolipoprotein A(APOA),apolipoprotein B(APOB),white blood cell count(WBC),hemoglobin(HGB),platelet count(PLT),neutrophil count(NEU),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),parathyroid hormone(PTH),β2 microglobulin(β2-MG)level before and after treatment were compared between the two groups.Results After treatment,the levels of TC,TG,LDL-C,APOA,and APOB in the observation group were(4.85±0.32)mmol/L,(3.64±0.35)mmol/L,(4.08±0.60)mmol/L,(1.09±0.16)g/L,and(0.81±0.07)g/L,which were significantly lower than(5.64±0.67)mmol/L,(5.71±0.33)mmol/L,(3.74±0.65)mmol/L,(1.46±0.20)g/L,(1.25±0.10)g/L of the control group(P<0.05);HDL-C level was(2.00±0.55)mmol/L,which was significantly higher than(1.41±0.42)mmol/L in the control group(P<0.05).After treatment,the blood routine indexes showed no statistically significant difference between the two groups(P>0.05).After treatment,the levels of PT,APTT,TT,FIB,PTH,andβ2-MG in the observation group were(12.17±0.48)s,(26.52±2.16)s,(11.46±0.25)s,(12.23±0.36)g/L,(73.36±5.14)pg/mL,(23.96±2.73)μmol/L,which were significantly lower than(13.69±0.54)s,(29.75±2.08)s,(13.40±0.30)s,(14.80±0.53)g/L,(85.24±7.05)pg/mL,(29.80±3.35)μmol/L in the control group (P<0.05). Conclusion Hemodialysis combined with hemoperitoneum therapy for patients with abnormal lipid metabolism undergoing MHD can effectively improve blood lipid level and reduce coagulation function and PTH level, which is worthy of clinical application.