Mediating role of social support in dysphoria,despondency,and quality of life in patients undergoing maintenance hemodialysis

BACKGROUND Dysphoria and despondency are prevalent psychological issues in patients undergoing Maintenance Hemodialysis(MHD)that significantly affect their quality of life(QOL).High levels of social support can significantly improve the physical and mental well-being of patients undergoing MHD.Currently,there is limited research on how social support mediates the relationship between dysphoria,despondency,and overall QOL in patients undergoing MHD.It is imperative to investigate this mediating effect to mitigate dysphoria and despondency in patients undergoing MHD,ultimately enhancing their overall QOL.AIM To investigate the mediating role of social support in relationships between dysphoria,despondency,and QOL among patients undergoing MHD.METHODS Participants comprised 289 patients undergoing MHD,who were selected using a random sampling approach.The Social Support Rating Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and QOL Scale were administered.Correlation analysis was performed to examine the associations between social support,dysphoria,despondency,and QOL in patients undergoing MHD.To assess the mediating impact of social support on dysphoria,despondency,and QOL in patients undergoing MHD,a bootstrap method was applied.RESULTS Significant correlations among social support,dysphoria,despondency,and quality in patients undergoing MHD were observed(all P<0.01).Dysphoria and despondency negatively correlated with social support and QOL(P<0.01).Dysphoria and despondency had negative predictive impacts on the QOL of patients undergoing MHD(P<0.05).The direct effect of dysphoria on QOL was statistically significant(P<0.05).Social support mediated the relationship between dysphoria and QOL,and this mediating effect was significant(P<0.05).Similarly,the direct effect of despondency on QOL was significant(P<0.05).Moreover,social support played a mediating role between despondency and QOL,with a significant mediating effect(P<0.05).CONCLUSION These findings suggest that social support plays a significant mediating role in the relationship between dysphoria,despondency,and QOL in patients undergoing MHD.

Meta analysis on the effectiveness of auricular therapy combined with modern medicine in the treatment of depression/anxiety disorders in maintenance hemodialysis patients

Objective:We used meta-analysis to explore the clinical efficacy of auricular point therapy combined with modern medicine in improving depression/anxiety in maintenance hemodialysis patients.Methods:We searched CNKI,Wanfang,Weipu,CBM,The Cochrane Library,PubMed,Web of Science,Embase through computer to build a randomized controlled trials of auricular therapy combined with modern medicine in the treatment of depression/anxiety disorders in China and abroad since 2022.Two evaluators independently screened the studies,extracted and cross-checked the key data in the studies independently after determining the included studies,and then evaluated the quality of the studies respectively.Finally,we used RevMan 5.3 platform for statistical processing of data.Results:This meta-analysis included a total of 12 clinical randomized controlled trials,including a total of 899 patients.The results showed that the observation group was more effective in reducing the scores of Hamilton Anxiety Scale,self rating Anxiety Scale,self rating Depression Scale,Pittsburgh sleep quality index score of maintenance hemodialysis patients.In addition,there was no statistical difference between the observation group and the control group in improving the total clinical effective rate.Conclusion:The observation group has a more obvious effect on the improvement of anxiety or depression in maintenance hemodialysis patients.However,due to the limitation of the quantity and quality of the included studies,the real efficacy of auricular therapy combined with modern medicine in improving anxiety or depression disorder after maintenance hemodialysis still needs to be supported by more carefully designed and standardized multi-center,large-sample clinical studies.

罗沙司他联合蔗糖铁治疗对MHD患者铁代谢及氧化应激的影响

目的:探讨罗沙司他联合蔗糖铁治疗对维持性血液透析(MHD)患者铁代谢及氧化应激的影响。方法:按照治疗方法不同将104例MHD患者分为蔗糖铁组(蔗糖铁治疗)和罗沙司他组(蔗糖铁+罗沙司他治疗),每组各52例,两组患者均治疗12周。比较两组治疗前后的血小板计数(PLT)、铁代谢指标[血清铁(SI)、总铁结合力(TIBC)、血清铁饱和度(ISAT)]、贫血指标[血红蛋白(Hb)、红细胞计数(RBC)、血细胞比容(Hct)和Hb达标率]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)及谷胱苷肽过氧化物酶(GSH-Px)]及不良反应发生情况。结果:治疗后,两组患者PLT、SI、TIBC、SIAT、Hb、RCB、Hct和Hb达标率,且罗沙司他组高于蔗糖铁组(P<0.05);血清MDA均较治疗前升高,但罗沙司他组低于蔗糖铁组(P<0.05);血清SOD、GSH-Px均较治疗前降低,但罗沙司他组高于蔗糖铁组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:罗沙司他联合蔗糖铁注射液治疗MHD疗效较明确,能提升PLT,改善铁代谢异常、贫血和氧化应激反应,且不良反应较少,值得临床推广。

赋能教育配合无缝隙护理预防MHD患者AVF并发症的临床价值

目的 观察赋能教育配合无缝隙护理模式预防维持性血液透析(maintenance hemodialysis disease,MHD)患者动静脉内瘘(arteriovenous fistula,AVF)并发症的价值。方法 选取2021年6月—2023年6月于福建医科大学附属第二医院东海院区接受MHD的280例患者。按收治时间进行分组,其中2021年6月—2022年5月收治的患者纳入对照组(n=140),2022年6月—2023年6月收治的患者纳入研究组(n=140)。对照组行常规护理,研究组在其基础上予以赋能教育配合无缝隙护理。观察2组内瘘闭塞、动脉瘤样扩张情况、AVF发生情况,评估2组患者干预前后的生活质量。结果 干预后,研究组内瘘闭塞发生率、动脉瘤样扩张发生率分别为4.29%、7.86%,低于对照组的10.71%、16.43%(P <0.05)。研究组患者AVF并发症总发生率为5.71%,低于对照组的17.14%(P <0.05)。干预后2组健康、情感以及心理评分均增加,且研究组高于对照组(P <0.05)。结论 赋能教育配合无缝隙护理模式能够有效预防MHD患者AVF并发症的发生,同时有利于MHD患者生活质量的提高。

日记式饮食健康教育对MHD患者的护理效果观察

目的:探究日记式饮食健康教育模式对维持性血液透析(MHD)患者护理效果。方法:选取2022年3月~2023年3月本院收治的维持性血液透析MHD82例患者为研究对象,采用随机数字表法将患者分为接受常规教育干预的对照组(41例)和接受日记式饮食健康教育干预的观察组(41例)。比较两组患者营养状态、饮食健康信念及自我管理能力。结果:观察组营养良好患者占比显著高于对照组,且观察组重度营养不良患者占比显著低于对照组(P<0.05)。干预后两组患者自觉行动效益、自觉行动障碍、自觉疾病严重性、自觉疾病易感性及自觉自我效能均较干预前有显著升高,且干预后观察组患者自觉行动效益、自觉行动障碍、自觉疾病严重性、自觉疾病易感性及自觉自我效能均显著高于对照组(P<0.05)。干预后两组患者饮食与液体摄入、身体活动、心理调节、治疗行为以及自我管理水平评分均较干预前有显著提高,且干预后观察组患者饮食与液体摄入、身体活动、心理调节、治疗行为以及自我管理水平评分均显著高于对照组(P<0.05)。结论:采用日记式饮食健康教育模式对维持性血液透析MHD患者进行干预效果显著,可显著改善患者营养状态,同时提高患者饮食健康信念并提高患者自我管理水平,值得临床推广。

不同颈内静脉隧道式导管封管液对预防MHD患者CRBSI及导管功能不良的影响

目的探讨不同颈内静脉隧道式导管封管液对预防维持性血液透析(MHD)患者导管相关性血流感染(CRBSI)、导管功能不良的影响。方法选取2020年1月~2021年7月在本院接受治疗的MHD患者100例,采用随机数表法分为A组(35例)、B组(31例)、C组(34例)。其中A组患者给予肝素钠盐水封管,B组患者采用定期尿激酶、肝素联合封管,C组患者采用4%枸橼酸钠封管,记录并对比3组患者的CRBSI、栓塞发生情况以及其他相关指标。结果3组患者的一般资料比较差异无统计学意义(P>0.05),A组导管栓塞率均高于B、C组(P<0.05),3组患者耳鸣、低血压差异无统计学意义(P>0.05)。相较于透析前,3组透析后的凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)差异均无统计学意义(P>0.05),且3组同一时间的以上凝血功能指标差异均无统计学意义(P>0.05)。A组患者尿素清除指数(Kt/V)、导管有效血流量均低于B、C组,A组导管使用时间长于B、C组(P<0.05),B、C组间以上指标差异均无统计学意义(P>0.05)。3组患者治疗后2、4个月的无CRBSI生存率差异均无统计学意义(P>0.05),A组治疗6个月无CRBSI生存率低于B、C两组(P<0.05)。结论肝素钠盐水、定期尿激酶联合肝素、4%枸橼酸钠均可作为MHD患者颈内静脉隧道式导管封管液,但定期尿激酶联合肝素以及4%枸橼酸钠可以降低CRBSI以及导管功能不良的发生风险,且相较于肝素钠盐水封管可以延长导管使用寿命。

Association between serum cartilage oligomeric matrix protein and coronary artery calcification in maintenance hemodialysis patients

Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.

Effects of Lanthanum Carbonate on Vascular Calcification in Elderly Maintenance Hemodialysis Patients

Summary： The effect of lanthanum carbonate on abdominal aortic calcification （AAC） in the elderly maintenance hemodialysis （MHD） patients was investigated. Fifty-four cases subjected to routine MHD complicated with skin pruritus admitted to our hospital were selected and randomly divided into case group （n=28） and control group （n=26）. The control group was given routine MHD alone. The case group was given lanthanum carbonate additionally on the basis of routine MHD. The changes of itching degrees at first and third month, and serum calcium, phosphorus, calcium-phosphorus products, intact parathyroid hormone （iPTH） levels and AAC scores at third month after treatments were compared be- tween the two groups. The correlation between calcium-phosphorus products and AAC scores was also analyzed. There was no significant difference in the baseline of blood urea nitrogen （BUN）, serum creatinine （Scr）, uric acid, albumin, hemoglobin, C reactive protein （CRP）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, triglyceride, total cholesterol between case group and control group （P〉0.05 for all）. There was also no significant difference in the baseline itching scores between the case group and the control group （P〉0.05）. At 1st and 3rd month after treatment, the itching scores in the case group were 14.2±3.2 and 10.5±2.3, respectively, which were significantly lower than the baseline and those in the control group （P〈0.05 for all）. At 1 st and 3rd month after treatment, the itching scores in the control group were 23.6v5.9 and 24.8±6.3, respectively, which were significantly higher than the baseline （P〈0.05）. There was no significant difference in the baseline of serum calcium, phos- phorus, calcium-phosphorus products, iPTH levels between the case group and control group （P〉0.05）. At 3rd month after treatment, serum phosphorus, calcium-phosphorus products and iPTH levels in the case group were decreased significantly as compared with the baseline （P〈0.05）, and the serum calcium, phosphorus, calcium-phosphorus products, and iPTH levels were statistically decreased as compared with those in the control group （P〈0.05）. The AAC scores showed statistically significant difference between the case group and the control group （P〈0.05）. The serum phosphorus and AAC scores showed a positive correlation in both two groups. It was suggested that the administration of lanthanum carbon- ate in the elderly MHD patients can effectively relieve itching, and simultaneously reduce serum phos- phorus and iPTH levels, resulting in the attenuation of vascular calcification.

The effect of Levocarnitine on nutritional status and lipid metabolism during long-term maintenance hemodialysis

Objective To investigate the effect of Levocarnitine on lipid metabolism and nutritional status of maintenance hemodialysis(MHD)patients and possible mechanism.Methods A total of 40 MHD patients [mean age(53.5±7.1)years] who underwent normal hemodialysis more than 6 months were randomly classified into two groups,Levocarnitine supplemented group(LS-G)(n=20;Levocarnitine supplementation after each normal hemodialysis session,at a dose of 1.0 g/day by intravenous administration)and control group(C-G)(n=20;normal hemodialysis).Before treatment,one month and three months after treatment we respectively measured or observed the following items,the tolerance to hemodialysis,carnitine level in plasma,C-reactive protein,IL-6,TNF-α,percentage of neutrophil,and some relevant nutritional parameters,such as lipid profile,transferrin,total protein,albumin and prealbumin levels.Comparative analysis was conducted between the two groups.Results In LS-G three months after treatment,the levels of carnitine,hemoglobin,and prealbumin in plasma were significantly increased(P<0.05),but C-reactive protein,neutrophil percentage,low-density lipoprotein and triglyceride were significantly decreased(P<0.05)in contrast to those in C-G and before treatment.Transferrin,total protein,and albumin were elevated in LS-G,with no statistical significance.Conclusion There was a significant improvement of lipid metabolism and nutritional status for the long-term maintenance hemodialysis patients with Levocarnitine supplementation.And this improvement is related to the decrease of inflammatory factors.

Hepc/25(OH)D3、EPO、sTfR-F与慢性肾衰竭MHD患者肾性贫血关系及联合预测并发感染的ROC分析

目的:探讨铁调素与维生素D3比值[Hepc/25(OH)D3]、促红细胞生成素(EPO)、可溶性转铁蛋白受体/铁指数(sTfR-F)与慢性肾衰竭维持性血液透析(MHD)患者肾性贫血的关系及联合预测并发感染的价值。方法:选取2018年1月-2020年12月我院139例慢性肾衰竭MHD患者,根据透析1个月内是否并发感染分为感染组(n=32)、非感染组(n=107),比较两组Hepc/25(OH)D3、EPO、sTfR-F、血红蛋白(Hb)、转铁蛋白饱和度(TSAT)、血细胞比容(HCT),分析Hepc/25(OH)D3、EPO、sTfR-F与肾性贫血相关指标关系、感染相关影响因素及各指标预测感染的价值。结果:感染组Hepc/25(OH)D3、sTfR-F高于非感染组,EPO低于非感染组(P<0.05);感染组Hb、TSAT、HCT低于非感染组(P<0.05);Hepc/25(OH)D3、sTfR-F与Hb、TSAT、HCT呈负相关,EPO与Hb、TSAT、HCT呈正相关(P<0.05);Hepc/25(OH)D3、EPO、sTfR-F均为慢性肾衰竭MHD患者发生感染的影响因素(P<0.05);Hepc/25(OH)D3、EPO、sTfR-F预测慢性肾衰竭MHD患者并发感染的曲线下面积(AUC)分别为0.810、0.784、0.765,各指标联合预测的AUC最大,为0.864。结论:Hepc/25(OH)D3、EPO、sTfR-F与慢性肾衰竭MHD患者肾性贫血密切相关,且是感染发生的影响因素,各指标联合在预测感染发生方面具有较高应用价值。

Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis:A systematic review and meta-analysis

BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease,a group of patients known to be particularly susceptible to infectious complications.AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODS We searched PubMed/MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Web of Science databases for relevant terms and imported the results into the Covidence platform.From there,studies were assessed in two stages for relevance and quality,and data from studies that satisfied all the requirements were extracted into a spreadsheet.The data was then analyzed descriptively and statistically.RESULTS Of the 920 studies identified through the initial database search,only 17 were included in the final analysis.The studies included in the analysis were mostly carried out during the first wave.We found that COVID-19 incidence among patients on hemodialysis was significant,over 10%in some studies.Those who developed COVID-19 infection were most likely going to be hospitalized,and over 1 in 5 died from the infection.Intensive care unit admission rate was lower than the infection lethality rate.Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections,and a significant proportion was infected during the first wave.Their prognosis is overall much worse than in the general population,and every effort needs to be made to decrease their exposure.

碳酸钙D_(3)与碳酸司维拉姆治疗对MHD患者矿物质及骨代谢异常的临床疗效对比

目的对比碳酸钙D_(3)与碳酸司维拉姆治疗对维持性血液透析(maintenance hemodialysis,MHD)患者矿物质及骨代谢异常的疗效。方法随机选取2020年1月—2021年12月期间在厦门大学附属福州第二医院接受血液透析治疗的60例MHD患者为研究对象,依据患者的治疗药物差异将其分入观察组(30例)和对照组(30例),对照组MHD患者采用碳酸钙D_(3)治疗,观察组MHD患者采用碳酸司维拉姆治疗。比较两组MHD患者治疗优良率和骨代谢异常、血钙及矿物质水平改善情况、不良反应发生率。结果观察组优良率为96.67%,高于对照组的73.33%,差异有统计学意义(χ^(2)=4.706,P=0.030)。治疗前两组抗酒石酸酸性磷酸酶5b、骨特异性碱性磷酸酶、Ⅰ型胶原羧基端交联端肽、骨钙素表达水平等骨代谢水平、血钙和血清甲状旁腺素、磷等矿物质水平相比,差异无统计学意义(P>0.05);治疗后两组各指标均显著改善,且观察组抗酒石酸酸性磷酸酶5b、骨特异性碱性磷酸酶、Ⅰ型胶原羧基端交联端肽、骨钙素表达水平等骨代谢水平、血钙和血清甲状旁腺素、磷等矿物质水平改善情况优于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论碳酸司维拉姆对MHD患者矿物质及骨代谢异常改善的效果明显优于碳酸钙D_(3),能有效提升总体疗效,是一种安全高效的治疗药物。

基于SHEL分析法的综合管理模式在提高MHD患者血管通路护理质量中的应用

目的:探讨基于SHEL分析法的综合管理模式在提高维持性血液透析(MHD)患者血管通路护理质量中的应用效果。方法:选取2020年4月1日~2022年5月31日收治的100例MHD患者作为研究对象。将2020年4月1日~2021年4月30日采用常规护理管理的50例患者作为对照组,将2021年5月1日~2022年5月31日采用基于SHFL分析法的综合管理模式的50例患者作为观察组;比较两组血管通路再循环情况、并发症发生情况、干预前后自我管理行为及生活质量[采用健康调查简表(SF-36)]。结果:观察组血尿素氮(BUN)再循环率及血肌酐(Cr)再循环率均低于对照组(P<0.01);观察组并发症发生率低于对照组(P<0.01);干预后,两组自我管理量表中情绪处理、自我护理、问题解决、伙伴关系评分及总分均高于干预前(P<0.05),且观察组高于对照组(P<0.01);干预后,两组SF-36中总体健康、生命力、心理健康、躯体疼痛、生理机能、社会职能、情感职能、生理职能评分均高于干预前(P<0.05),且观察组高于对照组(P<0.01)。结论:采用基于SHEL分析法的综合管理模式对MHD患者进行干预,可降低血管通路再循环率、并发症发生率,提升患者自我管理行为、生活质量,提高患者血管通路的护理质量。

Effects of mindfulness-based stress reduction therapy on anxiety and depression in patients with maintenance hemodialysis:a meta analysis

Objective:This study aimed to evaluate the effects of mindfulness-based stress reduction therapy on anxiety and depression in patients with maintenance hemodialysis.Methods:CNKI,VIP,WanFang,CBM,Embase,the Cochrane Library and PubMed databases were retrieved.Randomized controlled trials of intervention effects of mindfulness-based stress reduction combined with conventional hemodialysis education compared with conventional hemodialysis education on maintenance hemodialysis patients were collected.The retrieval period was from the establishment of the database to December 2019.Two researchers independently screened the literatures,extracted the data and evaluated the risk of bias in the included studies.RevMan 5.3 software was used for analysis.Results:A total of 9 studies,which comprised a total of 664 participants were included in the final meta analysis.The results showed that mindfulness-based stress reduction could reduce the anxiety of patients(SMD=?1.65,95%CI:?2.29 to?1.01),reduce the depression(SMD=?1.44,95%CI:?1.85 to?1.03).Conclusion:Mindfulness-based stress reduction therapy has positive effects on depression,anxiety in patients with maintenance hemodialysis.

Clinical study of predicting the occurrence and development of coronary heart disease by FT3 level in maintenance hemodialysis patients

Objective:To investigate the clinical significance of FT3 level in predicting the occurrence and development of coronary heart disease in maintenance hemodialysis patients.Methods:95 Patients who underwent maintenance hemodialysis in our hospital from January 2016 to December 2017 were selected as subjects. According to whether has coronary heart disease was divided into coronary heart disease group and non coronary heart disease group, the difference of FT3 level and related laboratory indexes was observed. ROC curve analysis and COX multiple factor risk regression were used to analyze the predictive value of FT3 level on the occurrence and development of heart disease in MHD patients.Results:The concentration of FT3, Hb and ALB in CHD group was lower than that of non-CHD group (P<0.05), and the content of TG, TC, LDL-C, Hcy and Hs-CRP were significantly higher than that of non-CHD group (P<0.05). FT3 was positively correlated with Hb and ALB (T=0.821, 0.809,P<0.05), and was negatively correlated with TG, TC, LDL-C, Hcy and Hs-CRP (T=- 0.814, - 0.843, - 0.904, - 0.806, - 0.912,P<0.05). The ROC curve analysis showed that the area of AUC of FT3 was the highest, 0.864 (95%, CI:0.803~0.935), the sensitivity and specificity was 86.5% and 89.3% respectively. The area of combined diagnosis of AUC was 0.904 (95%CI:0.867~0.976), the sensitivity and specificity was 85.6% and 94.5%, respectively. After analyzing the COX risk regression model and correcting the above laboratory indicators, FT3 is an independent risk factor (HR: 0.58, 95%, CI: 0.41~0.72,P<0.05) for the adverse prognosis of MHD patients with coronary heart disease.Conclusion:It is of high clinical value to predict the development of coronary heart disease in MHD patients by FT3 level, and its mechanism may be related to the reduction of thyroxine synthesis, inflammatory reaction and atherosclerosis.

Occult hepatitis C virus infection is more common than hepatitis B infection in maintenance hemodialysis patients

Patients of end stage renal disease on maintenance hemodialysis were enrolled to study the prevalence of occult and dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and non-occult hepatitis B and C virus infection. One hundred and two patients were enrolled. Thirty patients had HCV infection, three of them were positive in anti-HCV. So, 27 (90%) of HCV-positive patients had occult HCV infection. Eleven (11%) patients had HBV infection. Five patients were positive in anti-HBc or HBV-DNA, but negative in HBsAg (occult HBV infection). Three (3%) patients had dual HBV and HCV infection. None of the patients showed changes in viral markers during the follow-up of 8 mo on average (1-12 mo).

团体认知行为干预对MHD患者认知功能和生活质量的影响

目的探讨团体认知行为干预对MHD患者认知功能和生活质量的影响。方法按照随机数字表法将80例MHD患者分成对照组和观察组,各40例。对照组采用常规临床干预,观察组在对照组基础上联合团体认知行为干预。观察2组治疗前后心理状态评估焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、心理韧性量表(CD-RISC)评分、血液透析患者压力源表(HSS)评分、蒙特利尔认知评估量表(MoCA)评分、日常生活能力量表(ADL)评分及生活质量量表(SF-36)评分的变化情况;比较2组护理满意度。结果观察组治疗后SAS评分、SDS评分、HSS评分、ADL评分均低于对照组(P<0.05);CD-RISC评分、MoCA评分、SF-36评分高于对照组(P<0.05);观察组护理满意度为92.5%,明显高于对照组护理满意度72.5%(P<0.05)。结论团体认知行为干预能够调节MHD患者心理状态,增强心理韧性,提高患者认知功能和生活质量,改善护理满意度。

Correlation of EPO resistance with oxidative stress response and inflammatory response in patients with maintenance hemodialysis

Objective: To study the correlation of erythropoietin (EPO) resistance with oxidative stress response and inflammatory response in patients with maintenance hemodialysis. Methods: A total of 184 patients with end-stage renal disease who received maintenance hemodialysis in Shaanxi Provincial People's Hospital between March 2015 and October 2016 were selected as dialysis group, 102 volunteers who received physical examination in Shaanxi Provincial People's Hospital during the same period were selected as control group, the EPO resistance index was assessed, the median was calculated, and serum oxidative stress and inflammatory response indexes were detected. Results: Serum T-AOC, SOD and CAT levels in dialysis group were significantly lower than those in control group while MDA, AOPP, IFN-γ, HMGB-1, ICAM-1, IL-4 and IL-10 levels were significantly higher than those in control group;serum T-AOC, SOD and CAT levels in patients with high ERI were significantly lower than those in patients with low ERI while MDA, AOPP, IFN-γ, HMGB-1, ICAM-1, IL-4 and IL-10 levels were significantly higher than those in patients with low ERI. Conclusion: The degree of EPO resistance in patients with maintenance hemodialysis is closely related to the activation of oxidative stress response and inflammatory response.

Effect of compound α-ketoacid combined with routine nutritional intervention on inflammatory response and oxidative stress response in patients with maintenance hemodialysis

Objective: To study the effect of compound α-ketoacid combined with routine nutritional intervention on the inflammatory response and oxidative stress response in patients with maintenance hemodialysis. Methods: A total of 78 patients with uremia who received maintenance hemodialysis in Dangyang Changbanpo Hospital between February 2014 and November 2016 were collected and divided into control group and observation group according to the random number table method, 39 cases in each group. The control group received routine nutritional intervention, and the observation group underwent compound α-ketoacid combined with routine nutritional intervention. The serum levels of inflammatory factors and oxidative stress indicators in two groups of patients were detected before dialysis and 6 months after dialysis. Results: Before dialysis, differences in serum levels of inflammatory factors and oxidative stress indexes were not statistically significant between two groups of patients. After dialysis, serum CRP, IL-6, TNF-α, MDA and AOPP levels of both groups of patients were significantly higher than those before dialysis while SOD and GSHPx levels were significantly lower than those before dialysis and serum CRP, IL-6, TNF-α, MDA and AOPP levels of observation group after dialysis were significantly lower than those of control group while SOD and GSHPx levels were significantly higher than those of control group. Conclusions:Compound α-ketoacid combined with routine nutritional intervention can effectively reduce the systemic microinflammatory state and inhibit the oxidative stress response in patients with maintenance hemodialysis.

Effect of nephrotic enteral nutrition preparation on the nutritional status and microinflammatory state in patients with maintenance hemodialysis complicated by malnutrition

Objective:To study the effect of nephrotic enteral nutrition preparation on the nutritional status and microinflammatory state in patients with maintenance hemodialysis complicated by malnutrition.Methods: A total of 68 patients who received maintenance hemodialysis and had malnutrition in our hospital between January 2013 and July 2016 were collected and divided into control group (n=34) and observation group (n=34) according to random number table. Control group received regular dietary intervention, and observation group received nephrotic enteral nutrition preparation based on routine intervention. Nutritional status and microinflammatory state before and after intervention were compared between two groups of patients.Results: Before intervention, the differences in peripheral blood levels of protein indexes and trace elements as well as serum levels of inflammatory factors were not statistically significant between two groups of patients. After intervention, peripheral blood nutrition-related proteins TP, ALB, PA, Hb and TRF levels of observation group were higher than those of control group;peripheral blood trace elements Zn and Fe levels were higher than those of control group while Ca level was lower than that of control group;serum inflammatory factors IL-6, hs-CRP and TNF-α levels were lower than those of control group. Conclusion:Nephrotic enteral nutrition preparation can effectively optimize the nutritional status and reduce the microinflammation degree in patients with maintenance hemodialysis complicated by malnutrition.