血液灌流频率与糖尿病终末期肾病患者微炎症状态的相关性

Correlation of hemoperfusion frequency with the microinflammatory status in the diabetes mellitus end stage renal disease patients

目的探讨血液灌流(HP)频率与糖尿病终末期肾病(ESRD)微炎症状态的相关性。方法选取行常规血液透析(HD)治疗的糖尿病ESRD患者98例,按照随机数字表法分为对照组以及观察组A、B、C。对照组:常规HD治疗,每周3次,每次4 h。观察组A:在对照组基础上联合一周1次HP;观察组B:在对照组基础上联合每2周1次HP;观察组C:在对照组基础上联合每4周1次HP。4组患者分别于治疗前、治疗24周后检测炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)]及肾功能[血肌酐(SCr)、尿素氮(BUN)],凝血功能[全血黏度(WBV)、血浆黏度(PV)、凝血酶时间(TT)]指标,记录治疗后各组患者的不良反应发生情况。结果治疗后各观察组微炎症、肾功能、凝血功能指标均较对照组有所改善(P<0.05),观察组A微炎症,肾功能指标水平,凝血功能指标中WBV、PV水平均低于观察组B、C,TT较观察组B、C更长(P<0.05)。各组患者治疗后恶心呕吐、发热、痉挛等不良反应发生率无统计学差异(P>0.05)。结论 HP与HD联合应用可较好地改善糖尿病ESRD患者的微炎症状态、肾功能及凝血功能,HD联合一周1次HP的疗效最佳。

Objective To explore the correlation between hemoperfusion(HP) frequency and microinflammatory status in diabetes mellitus end stage renal disease(ESRD) patients. Methods A total of 98 cases of diabetes mellitus ESRD treated with conventional hemodialysis(HD) were selected. The patients were randomly divided into control group and observation group A, B, and C. The control group patients were only treated with conventional HD at 3 times a week and 4 hours each time. Based on control group, the patients in observation groups were received additional hemoperfusion(HP) once a week(observation group A), once every 2 weeks(observation group B) and once every 4 weeks(observation group C). The levels of inflammatory factors(TNF-α, IL-6, hs-CRP), renal function indices(SCr, BUN) and coagulation function indices(WBV, PV, TT) were measured before and after treatment 24 weeks. The incidence of adverse reactions was recorded. Results After treatment, in three observation groups, these patients' inflammation indices, renal function indices and coagulation indices were better than those in control group(P<0.05). However, in observation group A, the levels of inflammation indices, renal function indices and levels of coagulation indices such as WBV and PV were lower than those in observation group B and C, and the level of TT was longer than that in observation group B and C(P<0.05). There was no significant difference on adverse reactions such as nausea and vomiting, fever, spasm observed in all groups after treatment(P>0.05). Conclusion The combination of HD with HP, especially once a week can improve the microinflammatory status in the patients with diabetes mellitus ESRD.