高通量血液透析对老年糖尿病肾病患者心功能超声指标、血清心肌损伤及炎症生化指标的远期改善作用

The long-term improvement effect of high flux hemodialysis on cardiac function ultrasound index,serum myocardial injury and inflammatory biochemical index in elderly patients with diabetic nephropathy

目的针对老年糖尿病肾病(DN)维持性血液透析(MHD)患者进行高通量透析(HFHD)治疗,评估治疗对患者心功能超声指标、血清心肌损伤及炎症生化指标的远期改善作用。方法选择2022年3月—2023年3月于温州市中西医结合医院接受MHD治疗的93例老年DN患者,根据患者需要和透析目的将其分为HFHD组42例和低通量透析(LFHD)组51例,并分别进行高通量透析和低通量透析。追踪治疗效果1年,并于追踪期结束比较患者组内、组间心功能超声指标、血清心肌损伤、炎症生化指标以及不良反应发生率差异。结果组内比较结果显示:治疗后,HFHD组患者左室舒张末期内径(LVDD)降低,左室射血分数(LVEF%)与舒张早期E峰值与舒张晚期A峰值的比值(E/A)上升,血清超敏肌钙蛋白Ⅰ(hs-TNⅠ)水平也呈现上升趋势(P<0.05);LFHD组hs-TNⅠ、Hcy、超敏C反应蛋白(hs-CRP)水平显著上升(P<0.05)。组间比较结果显示:治疗后,HFHD组LVDD、室间隔舒张期厚度(IVSDT)较LFHD组显著下降,LVEF%和E/A较LFHD组显著上升;HFHD组血清肌酸激酶同工酶质量(CK-MBmass)、hs-TNⅠ、同型半胱氨酸(Hcy)以及hs-CRP水平均显著低于LFHD组。HFHD组透析不良反应总发生率为11.90%(5/42),显著低于LFHD组[47.06%(24/51),P<0.001]。结论老年糖尿病肾病维持性血液透析患者行高通量透析治疗,可有效改善心功能,延缓心肌损伤水平,且安全性较高。

Objective High-flux hemodialysis(HFHD)was performed in elderly patients with diabetic nephropathy(DN)maintenance hemodialysis(MHD)to evaluate the long-term improvement of cardiac function ultrasound index,serum myocardial injury,and inflammatory biochemical index.Methods A total of 93 elderly patients with DN who received MHD treatment in Wenzhou Chinese and Western Medicine Hospital from March 2022 to March 2023 were selected and divided into a HFHD group(n=42)and a low-flux dialysis(LFHD)group(n=51)according to patients'needs and dialysis purposes.High-flux dialysis and low-flux dialysis were performed respectively,and the treatment effect was followed up for 1 year.At the end of the follow-up period,the differences in cardiac function ultrasound indexes,serum myocardial injury,inflammatory biochemical indexes,and incidence of adverse reactions were compared between the two groups.Results The results of intra-group comparison showed that;after treatment,the left ventricular end-diastolic diameter(LVDD)in the HFHD group decreased,the left ventricular ejection fraction(LVEF%)and the ratio of early diastolic E peak to late diastolic A peak(E/A)increased,and the serum high-sensitivity troponinⅠ(hs-TNⅠ)level also showed an upward trend(P<0.05).The levels of hs-TNⅠ,Hcy,and hs-CRP in the LFHD group were significantly increased(P<0.05).The results of inter-group comparison showed that after the treatment,LVDD and interventricular septum diastolic thickness(IVSDT)in the HFHD group were significantly lower than those in the LFHD group,while LVEF%and E/A were significantly higher than those in the LFHD group.The levels of serum creatine kinase isoenzyme mass(CK-MBmass),hs-TNⅠ,homocysteine(Hcy),and hypersensitive C-reactive protein(hs-CRP)in the HFHD group were significantly lower than those in the LFHD group.The total incidence of dialysis adverse reactions in the HFHD group was 11.90%(5/42),which was significantly lower than that in the LFHD group(47.06%,24/51,P<0.001).Conclusion HFHD treatment in elderly DN MHD patients can effectively improve cardiac function and delay myocardial injury with high safety.