血液透析并血液灌流联合双歧四联活菌治疗终末期慢性肾脏病对照研究

A controlled study of hemodialysis and hemoperfusion combined with Bifidobacterium tetravaccine capsules in the treatment of end-stage chronic kidney disease

目的探讨血液透析并血液灌流联合双歧四联活菌胶囊治疗终末期慢性肾脏病的临床疗效及对患者血清细胞因子、蛋白结合类毒素水平的影响。方法将114例终末期慢性肾脏病患者按随机数字表法分为研究组、对照组,各57例。对照组给予血液透析并血液灌流治疗,研究组在对照组基础上联合双歧四联活菌胶囊治疗,治疗2个月。比较治疗前后两组血清肾功能指标(尿酸、肌酐、尿素氮)、细胞因子(C反应蛋白、白细胞介素-6、降钙素原)、蛋白结合类毒素(硫酸对甲酚、硫酸吲哚酚)、细胞免疫功能指标(CD8^(+)、CD4^(+)、CD4^(+)/CD8^(+))、营养指标(白蛋白、血红蛋白、总蛋白)水平及肾脏疾病生活质量专用量表评分。结果(1)治疗2个月末两组血清肾功能指标(尿酸、肌酐、尿素氮)、细胞因子(C反应蛋白、白细胞介素-6、降钙素原)、蛋白结合类毒素(硫酸对甲酚、硫酸吲哚酚)水平均较治疗前显著下降(P<0.01),且研究组显著低于对照组(P<0.01)。(2)治疗2个月末两组血清CD8^(+)水平较治疗前显著下降(P<0.01),血清CD4^(+)、CD4^(+)/CD8^(+)水平较治疗前显著升高(P<0.01),且研究组CD8^(+)水平显著低于对照组(P<0.01),CD4^(+)、CD4^(+)/CD8^(+)水平显著高于对照组(P<0.01)。(3)治疗2个月末两组营养指标(白蛋白、血红蛋白、总蛋白)水平均较治疗前显著升高(P<0.01),研究组显著高于对照组(P<0.01)。(4)治疗2个月末两组肾脏疾病生活质量专用量表评分均较治疗前显著升高(P<0.01),研究组显著高于对照组(P<0.01)。结论血液透析并血液灌流联合双歧四联活菌胶囊治疗终末期慢性肾脏病,可清除代谢毒素与蛋白结合类毒素,保护肾功能,纠正营养状态,改善炎症状态与免疫功能,提高患者生存质量。

Objective To investigate the clinical efficacy of hemodialysis and hemoperfusion combined with Bifidobacterium tetravaccine capsules in the treatment of end-stage chronic kidney disease(CKD)and its effect on serum cytokine and protein-bound toxin levels.Methods A total of 114 patients with end-stage CKD were divided into study group and control group according to random number table method,with 57 cases in each group.The control group was given hemodialysis and hemoperfusion,and the study group was given Bifidobacterium tetravaccine capsules on the basis of the control group for 2 months.The serum renal function indexes[uric acid(UA),serum creatinine(Scr),blood urea nitrogen(BUN)],cytokines[C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT)],protein-bound toxins[P-cresol sulfate(PCS),indoxyl sulfate(IS)],cell immune function indicators(CD8^(+),CD4^(+),CD4^(+)/CD8^(+)),nutritional indexes[albumin(Alb),hemoglobin(Hb),total protein(TP)]and kidney disease quality of life-short formTM1.3(KDQOL-SFTM1.3)scores were compared between the two groups before and after treatment.Results(1)At the end of 2 months of treatment,the levels of serum renal function indexes(UA,Scr,BUN),cytokines(CRP,IL-6,PCT),protein-bound toxins(PCS,IS)in the two groups were significantly lower than those before treatment(P<0.01),and the study group was significantly lower than the control group(P<0.01).(2)At the end of 2 months of treatment,the levels of serum CD8^(+)in the two groups were significantly lower than those before treatment(P<0.01),and the levels of serum CD4^(+)and CD4^(+)/CD8^(+)were significantly higher than those before treatment(P<0.01).The level of CD8^(+)in the study group was significantly lower than that in the control group(P<0.01),and the levels of CD4^(+)and CD4^(+)/CD8^(+)were significantly higher than those in the control group(P<0.01).(3)At the end of 2 months of treatment,the levels of nutritional indexes(Alb,Hb,TP)in the two groups were significantly higher than those before treatment(P<0.01),and the study group was significantly higher than the control group(P<0.01).(4)At the end of 2 months of treatment,the KDQOL-SFTM1.3 scores of the two groups were significantly higher than those before treatment(P<0.01),and the study group was significantly higher than the control group(P<0.01).Conclusions Hemodialysis and hemoperfusion combined with Bifidobacterium tetravaccine capsules in the treatment of end-stage CKD can remove metabolic poisons and protein-bound toxins,protect renal function,correct nutritional status,improve inflammatory status and immune function,and improve the quality of life of patients.