序贯血液透析滤过联合血液灌流治疗糖尿病肾病维持性血液透析患者的价值研究

Value of Sequential Hemodiafiltration and Hemoperfusion in Treatment of Diabetic Nephropathy Patients with Maintenance Hemodialysis

目的:分析糖尿病肾病患者维持性血液透析期间应用序贯血液透析滤过联合血液灌流治疗的价值。方法:选取2021年1月-2022年1月上海健康医学院附属嘉定区中心医院收治的74例接受维持性血液透析治疗的糖尿病肾病患者作为研究对象,根据随机数字表法分为观察组和对照组,各37例。对照组应用序贯血液透析滤过治疗,观察组在对照组基础上联合血液灌流进行治疗,对比两组患者的各项血糖指标、胰岛素功能指标及血清炎性因子水平。结果:治疗前,两组空腹血糖(FBG)、餐后2 h血糖(2 hPBG)与糖化血红蛋白(HbA_(1c))水平比较,差异无统计学意义(P>0.05);治疗后,观察组FBG、2 hPBG、HbA_(1c)水平均低于对照组,差异有统计学意义(P<0.05)。治疗前,两组空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及胰岛素用量比较,差异无统计学意义(P>0.05);治疗后,观察组FINS、HOMA-IR及胰岛素用量均低于对照组,差异有统计学意义(P<0.05)。治疗前,两组血清肿瘤坏死因子α(TNF-α)、C-反应蛋白(CRP)及白细胞介素6(IL-6)水平比较,差异无统计学意义(P>0.05);治疗后,观察组血清TNF-α、CRP、IL-6水平均低于对照组,差异有统计学意义(P<0.05)。结论:糖尿病肾病患者维持性血液透析期间联合应用序贯血液透析滤过及血液灌流进行治疗,可有效提升整体治疗效果,更好地控制患者的血糖水平,改善机体胰岛素抵抗,有效抑制炎性反应。

Objective: To analyze the value of sequential hemodiafiltration and hemoperfusion in patients with diabetic nephropathy during maintenance hemodialysis.Methods:A total of 74 with diabetic nephropathy who received maintenance hemodialysis in Jiading District Central Hospital,Shanghai University of Medicine & Health Sciences from January 2021 to January 2022 were selected as the study subjects.They were divided into control group and observation group according to random number table method,with 37 cases in each group.The control group was treated with sequential hemodiafiltration.The observation group was treated with hemoperfusion on the basis of control group.The levels of various blood glucose indicators,insulin function indicators and serum inflammatory factors were compared between two groups.Results:Before treatment,there were no significant differences in fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPBG) and glycosylated hemoglobin(HbA_(1c)) levels between the two groups(P>0.05).After treatment,the levels of FBG 2 hPBG and HbA_(1c) in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in fasting insulin(FINS),insulin resistance index(HOMA-IR) and insulin dosage between the two groups(P>0.05).After treatment,the FINS,HOMA-IR and insulin dosage in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in the levels of serum tumor necrosis factor α(TNF-α),C-reactive protein(CRP) and interleukin 6(IL-6) between the two groups(P>0.05).After treatment,serum TNF-α,CRP and IL-6 levels in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion:The combined use of sequential hemodiafiltration and hemoperfusion in the treatment of diabetic nephropathy patients during maintenance hemodialysis can effectively improve the overall therapeutic effect,better control blood glucose level,improve insulin resistance,and effectively inhibit inflammatory response.