血液透析滤过联合金水宝片对糖尿病肾病患者血清炎性因子的影响

Effect of hemodiafiltration combined with Jinshuibao tablet on serum inflammatory factors in patients with diabetic nephropathy

目的分析血液透析滤过联合金水宝片对糖尿病肾病患者血清炎性因子及氧化应激指标的影响。方法选取2019年4月至2020年4月聊城市第二人民医院收治的糖尿病肾病患者86例为研究对象,采用随机数字表法分为两组,对照组(42例)采用血液透析滤过治疗,观察组(44例)在对照组基础上联合使用金水宝片治疗,比较两组微炎症状态、氧化应激指标水平、肾功能及营养状况。结果治疗前,对照组血清白细胞介素6(IL-6)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)分别为(30.13±3.25)ng/L、(9.43±2.57)mg/L、(46.69±3.54)ng/L,观察组分别为(30.16±3.34)ng/L、(9.48±2.65)mg/L、(46.73±3.38)ng/L,两组差异均无统计学意义(均P>0.05);治疗后,对照组血清IL-6、hs-CRP、TNF-α分别为(16.69±2.73)ng/L、(8.12±2.21)mg/L、(35.63±2.75)ng/L,观察组分别为(12.34±2.52)ng/L、(6.47±1.53)mg/L、(26.65±2.13)ng/L,治疗后两组血清IL-6、hs-CRP、TNF-α水平均低于治疗前(对照组:t=20.52、2.50、15.99,观察组:t=27.60、6.16、32.57,均P<0.05),治疗后观察组均低于对照组(t=7.68、4.04、16.97,均P<0.05)。治疗前,对照组血清丙二醛(MDA)、过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)分别为(5.63±1.36)nmol/L、(63.38±7.56)mU/L、(195.96±26.36)IU/L,观察组分别为(5.68±1.25)nmol/L、(63.25±7.38)mU/L、(195.83±26.27)IU/L,组间比较,差异均无统计学意义(均P>0.05);治疗后,对照组血清MDA、SOD、GSH-Px分别为(4.83±1.13)nmol/L、(83.46±5.75)mU/L、(236.69±18.75)IU/L,观察组分别为(4.24±0.86)nmol/L、(88.75±5.47)mU/L、(258.76±15.47)IU/L,治疗后两组血清MDA、SOD、GSH-Px均优于治疗前(对照组:t=2.93、13.70、8.16,P=0.002、<0.001、<0.001,观察组:t=6.15、17.99、13.37,均P<0.001);治疗后组间比较,观察组均优于对照组(t=2.73、4.37、5.96,P=0.004、<0.001、<0.001)。同时,治疗后,观察组血尿素氮(BUN)、血清肌酐(Scr)、24 h尿蛋白定量均低于对照组(t=7.85、8.71、2.06,P<0.001、<0.001、0.021),肌酐清除率(Ccr)高于对照组(t=3.01,P=0.002);血清总蛋白(TP)、前白蛋白(PA)、白蛋白(ALB)均高于对照组(t=9.47、12.13、6.18,均P<0.001)。结论采用血液透析滤过联合金水宝片治疗糖尿病肾病,对患者微炎症状态及氧化应激指标产生积极影响,可改善患者肾功能及机体营养状况。

Objective To investigate the effect of hemodiafiltration combined with Jinshuibao tablet on serum inflammatory factors and oxidative stress indices in patients with diabetic nephropathy.Methods A total of 86 patients with diabetic nephropathy who received treatment in The Second People's Hospital of Liaocheng from April 2019 to April 2020 were included in this study.They were randomly assigned to receive either hemodiafiltration(control group,n=42)or hemodiafiltration combined with Jinshuibao tablet(observation group,n=44).Microinflammatory state,oxidative stress index level,renal function and nutritional status were compared between the two groups.Results Before treatment,serum interleukin-6,high-sensitivity C-reactive protein and tumor necrosis factor-αlevels in the control group were(30.13±3.25)ng/L,(9.43±2.57)mg/L,(46.69±3.54)ng/L respectively,and they were(30.16±3.34)ng/L,(9.48±2.65)mg/L,(46.73±3.38)ng/L respectively in the observation group.There were no significant differences in these indices between the two groups(all P>0.05).After treatment,serum interleukin-6,high-sensitivity C-reactive protein and tumor necrosis factor-αlevels in the control group were(16.69±2.73)ng/L,(8.12±2.21)mg/L,(35.63±2.75)ng/L,respectively,and they were(12.34±2.52)ng/L,(6.47±1.53)mg/L,(26.65±2.13)ng/L,respectively in the observation group.After treatment,serum interleukin-6,high-sensitivity C-reactive protein and tumor necrosis factor-αlevels in both groups were significantly lower than those before treatment(control group:t=20.52,2.50,15.99;observation group:t=27.60,6.16,32.57,all P<0.05).After treatment,serum interleukin-6,high-sensitivity C-reactive protein and tumor necrosis factor-αlevels were significantly lower than those in the control group(t=7.68,4.04,16.97,all P<0.05).Before treatment,serum levels of malondialdehyde,superoxide dismutase,and glutathione peroxidase in the control group were(5.63±1.36)nmol/L,(63.38±7.56)mU/L,and(195.96±26.36)IU/L,respectively,while those in the observation group were(5.68±1.25)nmol/L,(63.25±7.38)mU/L,and(195.83±26.27)IU/L,respectively.There were no significant differences in these indices between the two groups(all P>0.05).After treatment,serum levels of malondialdehyde,superoxide dismutase,and glutathione peroxidase in the control group were(4.83±1.13)nmol/L,(83.46±5.75)mU/L and(236.69±18.75)IU/L respectively,while those in the observation group were(4.24±0.86)nmol/L,(88.75±5.47)mU/L and(258.76±15.47)IU/L,respectively.After treatment,serum levels of malondialdehyde,superoxide dismutase,and glutathione peroxidase in each group were superior to those before treatment(control group:t=2.93,13.70,8.16,P=0.002,<0.001,<0.001;observation group:t=6.15,17.99,13.37,all P<0.001).After treatment,serum levels of malondialdehyde,superoxide dismutase,and glutathione peroxidase in the observation group were superior to those in the control group(t=2.73,4.37,5.96,P=0.004,<0.001,<0.001).After treatment,blood urea nitrogen,serum creatinine and 24-hour urine protein in the observation group were significantly lower than those in the control group(t=7.85,8.71,2.06,P<0.001,<0.001,0.021),and creatinine clearance rate in the observation group was significantly higher than that in the control group(t=3.01,P=0.002).Total protein,prealbumin and albumin levels in the observation group were significantly higher than those in the control group(t=9.47,12.13,6.18,all P<0.001).Conclusion Hemodiafiltration combined with Jinshuibao tablet for the treatment of diabetic nephropathy has a positive effect on microinflammatory state and oxidative stress index level and improves patient's renal function and nutritional status.