血液透析滤过对非糖尿病终末期肾病患者胰岛素抵抗水平、微炎症状态及毒素清除能力的影响

The effect of hemodiafiltration on the level of insulin resistance,micro-inflammatory state and toxin removal ability in patients with non-diabetic end-stage renal disease

目的分析血液透析滤过对非糖尿病终末期肾病患者胰岛素抵抗水平、微炎症状态及毒素清除能力的影响。方法选取2017年3月至2019年3月本院肾病科收治的114例非糖尿病终末期肾病患者作为研究对象,采用随机数字表法将其分为对照组和观察组,每组57例。对照组给予高通量血液透析(HFHD),观察组给予血液透析滤过(HDF),比较两组患者胰岛素抵抗水平、微炎症状态及毒素清除能力。结果治疗前,两组胰岛素抵抗指数(HOMA-IR)、空腹胰岛素(FINS)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、瘦素(LEP)、血尿素氮(BUN)、血尿酸(BUA)、血肌酐(Scr)及血磷(P)水平比较差异均无统计学意义(均P>0.05)。治疗后,两组上述指标均下降,同时观察组优于对照组[HOMA-IR(1.64±0.25)vs(1.89±0.39);FINS(9.23±2.56)vs(11.04±3.02)m U/L;TNF-α(70.26±16.64)vs(78.56±20.45)pg/ml;IL-6(89.25±19.52)vs(98.27±25.47)pg/ml;CRP(6.89±2.02)vs(8.59±2.75)mg/L;LEP(6.68±1.12)vs(7.56±1.66)μg/L;BUN(8.25±1.12)vs(10.78±2.14)mmol/L;BUA(324.82±28.66)vs(453.23±35.16)mmol/L;Scr(316.29±24.59)vs(431.22±35.79)μmol/L;P(1.34±0.12)vs(1.65±0.23)mmol/L],差异均有统计学意义(均P<0.05)。结论HDF对非糖尿病ESRD患者治疗效果更佳,可以有效降低ESRD胰岛素抵抗水平、微炎症状态及毒素水平,改善体内酸碱平衡,提高ESRD患者的生活质量。

Objective This paper aims to analyze the effect of hemodiafiltration on the level of insulin resistance,micro-inflammatory state and toxin clearance in patients with non-diabetic end-stage renal disease.Methods A random number table was used to divide 114 patients with non-diabetic end-stage renal disease treated in the department of renal disease from March 2017 to March 2019 into two groups,with each group 57 patients.The control group was treated with high flux hemodialysis(HFHD),and the observation group was treated with hemodiafiltration(HDF).The two groups were compared as for the level of insulin resistance,micro-inflammatory state and toxin removal ability.Results The insulin resistance levels after treatment were lower than those before treatment,and the observation group was lower than the control group.[HOMA-IR(1.64±0.25)vs(1.89±0.39);FINS(9.23±2.56)vs(11.04±3.02)m U/L;TNF-α(70.26±16.64)vs(78.56±20.45)pg/ml;IL-6(89.25±19.52)vs(98.27±25.47)pg/ml;CRP(6.89±2.02)vs(8.59±2.75)mg/L;LEP(6.68±1.12)vs(7.56±1.66)μg/L;BUN(8.25±1.12)vs(10.78±2.14)mmol/L;BUA(324.82±28.66)vs(453.23±35.16)mmol/L;Scr(316.29±24.59)vs(431.22±35.79)μmol/L;P(1.34±0.12)vs(1.65±0.23)mmol/L],in the comparison of insulin resist-ance levels,the HOMA-IR,FINS,TNF-α,IL-6,CRP,LEP,BUN,BUA,Scr and P levels before treatment were not statistically significant(P>0.05).Conclusion Hemodiafiltration is more effective in treating non-diabetic ESRD patients.It can more effectively reduce ESRD insulin resistance,micro-inflammatory state and toxin removal ability,and adjust the acid-base balance in the human body,which correspondingly improve the quality of life of ESRD patients.