西沙必利辅助维持性血液透析治疗对老年慢性肾脏病患者胃肠功能紊乱调节作用的影响

Regulating effect of cisapride adjuvant therapy on gastrointestinal dysfunction in elderly patients with chronic kidney disease on maintenance hemodialysis

目的:探讨西沙必利辅助维持性血液透析(MHD)治疗对老年慢性肾脏病(CKD)患者胃肠功能、心肾功能、骨质疏松的影响。方法:选取2018年3月—2021年2月某院收治的老年CKD患者106例为研究对象,采用奇偶数分组法分为对照组和观察组,每组53例。对照组予以维持性血液透析治疗,观察组予以西沙必利辅助维持性血液透析治疗。比较2组患者治疗前后临床指标[红细胞分布宽度(RDW)、中性粒细胞/淋巴细胞比值(NLR)、血红蛋白(Hb)、白蛋白(ALB)、甲状旁腺素(PTH)]、肾功能指标[24 h尿量、血肌酐(Scr)、血尿素氮(BUN)]、胃肠功能指标[胃泌素(GAS)、血清生长抑素(SS)、胃动素(MOT)、血管活性肠肽(VIP)]、心功能指标[左心房内径(LAD)、左心室后壁舒张期厚度(LVPWDT)、室间隔舒张期厚度(IVSDT)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]、骨质疏松相关指标[骨保护素(OPG)、骨硬化蛋白(SOST)]及不良反应发生率。结果:治疗后,观察组患者RDW[(12.63±2.21)%]、NLR[(3.25±0.44)%]、PTH[(122.06±30.68)pg/mL]、Scr[(227.16±55.72)μmol/L]、BUN[(15.23±3.07)mmol/L]、MOT[(182.03±40.67)pmol/L]、LAD[(31.15±1.38)mm]、LVPWDT[(9.08±1.06)mm]、IVSDT[(9.12±1.14)mm]、LVEDD[(44.20±9.73)mm]、OPG[(224.27±54.75)ng/L]、SOST[(216.02±42.10)pg/mL]低于对照组[(13.84±2.61)%、(3.83±0.57)%、(177.03±39.01)pg/mL、(302.19±70.73)μmol/L、(21.06±4.02)mmol/L、(330.19±70.06)pmol/L、(38.02±2.67)mm、(12.68±2.22)mm、(12.29±2.09)mm、(52.27±10.45)mm、(362.06±95.68)ng/L、(312.18±94.11)pg/mL],Hb[(105.95±15.32)g/L]、ALB[(42.28±4.03)g/L]、24 h尿量[(588.61±106.20)mL]、LVEF[(68.78±9.26)%]高于对照组[(86.27±8.75)g/L、(32.22±3.07)g/L、(402.03±94.01)mL、(61.21±10.40)%],差异均有统计学意义(P<0.05)。观察组不良反应发生率为7.55%,低于对照组的22.64%,差异有统计学意义(P<0.05)。结论:西沙必利辅助治疗老年CKD-MHD患者,可改善患者临床指标,促进胃肠功能、心肾功能恢复,减缓骨质疏松发展进程,且安全性较高。

Objective:To investigate the effect of cisapride adjuvant therapy on gastrointestinal function, cardiorenal function and osteoporosis in elderly patients with chronic kidney disease(CKD)on maintenance hemodialysis(MHD).Methods:A total of 106 elderly patients with CKD were selected as the research objects, and divided into a control group and an observation group by odd-even grouping, with 53 cases in each group.The control group was given MHD,and the observation group received cisapride+MHD.Data of the two groups were compared, including pre-and post-operative clinical indicators[red blood cell distribution width(RDW), neutrophil/lymphocyte ratio(NLR), hemoglobin(Hb), albumin(ALB), para thyroid hormone(PTH)],renal function indicators[24-hour urine volume, serum creatinine(Scr),blood urea nitrogen(BUN)],gastrointestinal function indicators[gastrin(GAS), serum somatostatin(SS), motilin(MOT),vasoactive intestinal peptide(VIP)],cardiac function indicators[left atrial diameter(LAD),left ventricular posterior wall diastolic thickness(LVPWDT),ventricular septal diastolic thickness(IVSDT),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)],osteoporosis-related indicators[osteoprotegerin(OPG),sclerostin(SOST)],and incidence of adverse reactions.Results:After the treatment, RDW[(12.63±2.21)%],NLR[(3.25±0.44)%],PTH[(122.06±30.68)pg/mL],Scr[(227.16±55.72)μmol/L],BUN[(15.23±3.07)mmol/L],MOT[(182.03±40.67)pmol/L],LAD[(31.15±1.38)mm],LVPWDT[(9.08±1.06)mm],IVSDT[(9.12±1.14)mm],LVEDD[(44.20±9.73)mm],OPG[(224.27±54.75)ng/L],and SOST[(216.02±42.10)pg/mL] of the observation group were lower than those in the control group[(13.84±2.61)%,(3.83±0.57)%,(177.03±39.01)pg/mL,(302.19±70.73)μmol/L,(21.06±4.02)mmol/L,(330.19±70.06)pmol/L,(38.02±2.67)mm,(12.68±2.22)mm,(12.29±2.09)mm,(52.27±10.45)mm,(362.06±95.68)ng/L,(312.18±94.11)pg/mL],while Hb[(105.95±15.32)g/L],ALB[(42.28±4.03)g/L],24-h urine volume[(588.61±106.20)mL],LVEF[(68.78±9.26)%] were higher than those in the control group[(86.27±8.75)g/L,(32.22±3.07)g/L,(402.03±94.01)mL,(61.21±10.40)%](All P<0.05).The incidence of adverse reactions in the observation group was 7.55%, lower than the control group’s 22.64%(P<0.05).Conclusion:Adjuvant cisapride therapy can improve the clinical symptoms of elderly patients with CKD-MHD,promote the recovery of gastrointestinal function and cardiorenal function, and retard osteoporosis, with high safety.