基于炎症-营养、心血管不良事件探究HD+HP在继发性甲状旁腺功能亢进症患者中的应用

Exploring HD+HP in patients with secondary hyperparathyroidism based on inflammatory-nutritional,cardiovascular adverse events

目的探讨HA树脂血液灌流(hemoperfusion,HP)+血液透析(hemodialysis,HD)对继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者炎症-营养状态、心血管不良事件的影响。方法选取2021年6月~2022年6月伴有SHPT的患者进行前瞻性研究,采取随机数字表法分组,每组各400例。对照组每周3次HD治疗,观察组每周3次HD+HP治疗。比较2组临床疗效及治疗前后小分子指标[血磷、血钙、碱性磷酸酶(ALP)]、中大分子指标[全段甲状旁腺激素(iPTH)、β_(2)-微球蛋白(β_(2)-MG)、胱抑素C(cystatin C,CysC)]、营养状态[血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(transferrin,TRF)]、炎症指标[白细胞介素-1(interleukin-1,IL-1)、C反应蛋白(CRP)、肿瘤坏死因子α(tumor ne-crosis factor alpha,TNF-α)、IL-6]及心血管事件发生情况。结果观察组疗效总有效率高于对照组(93.25%比77.25%,χ^(2)=40.718,P<0.001)。治疗后2组ALP、血磷、血钙比较均无显著差异(t=1.017,1.305,0.603,P=0.309,0.192,0.547);治疗后观察组iPTH、CysC、β_(2)-MG水平低于对照组,ALB、PA、TRF水平高于对照组(t=42.160,21.114,20.480,28.321,33.596,37.387,均P<0.001);与治疗后对照组相比,观察组IL-6、CRP、TNF-α、IL-1水平均较低(t=17.164,16.131,8.024,21.639,均P<0.001);观察组心血管事件发生率低于对照组(4.75%比10.50%,χ^(2)=9.388,P=0.002)。结论HP联合HD治疗可提高小分子、中大分子等毒性物质清除效果,维持机体营养、代谢平衡,改善过度炎症反应状态,减少心血管事件发生,从而提高治疗效果,值得临床推广。

Objective To investigate the effect of HA resin haemoperfusion(HP)+haemodialysis(HD)on inflammatory-nutritional status and adverse cardiovascular events in patients with secondary hyperparathyroidism(SHPT).Methods 800 patients with SHPT from June 2021 to June 2022 were selected for the prospective study and grouped by random number table method,400 patients in each group.The control group was treated with conventional haemodialysis(HD)3 times a week and the observation group was treated with conventional HD+HP 3 times a week.The clinical efficacy and small molecular indicators[blood phosphorus,serum calcium,alkaline phosphatase(ALP)],medium and large molecular indicators[intact parathyroid hormone(iPTH),β_(2)-microglobulin(β_(2)-MG),cystatin C(CysC)],nutritional status[serum albumin(ALB),prealbumin(PA),transferrin(TRF)],inflammation level[interleukin-1(IL-1),C-reactive protein(CRP),tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6)]and cardiovascular events.Results The total effective rate of the observation group was 93.25%higher than that of the control group 77.25%(χ^(2)=40.718,P=0.000);there was no significant difference between the two groups in terms of ALP,blood phosphorus and blood calcium levels after treatment(t=1.017,1.305,0.603,P=0.309,0.192,0.547);After treatment,the levels of iPTH,CysC,andβ_(2)-MG were lower in the observation group than in the control group,and the levels of ALB,PA,and TRF were higher than in the control group(t=42.160,21.114,20.480,28.321,33.596,37.387,all P<0.001);compared with the control group after treatment,the levels of IL-6,CRP,TNF-α,and IL-1 levels were lower in the observation group compared to the control group after treatment(t=17.164,16.131,8.024,21.639,all P<0.001);The incidence of cardiovascular events was lower in the observation group at 4.75%than in the control group at 10.50%(χ^(2)=9.388,P=0.002).Conclusion HP combined with HD treatment can improve the scavenging effect of small molecules,macromolecules and other toxic substances,maintain the nutritional and metabolic balance of the body,improve the state of excessive inflammatory response,and reduce the occurrence of cardiovascular events,thereby improving the therapeutic effect,which is worthy of clinical promotion.