血液灌流联合血液透析对糖尿病肾病患者的有效性和安全性  

Effectiveness and safety of hemoperfusion combined with hemodialysis in patients with diabetic nephropathy

作　　者：王婧 李晓雁 刘丽[3] 王海芳[4] Wang Jing;Li Xiaoyan;Liu Li;Wang Haifang(Department of Endocrinology,the Second Hospital of Chao Yang,Chaoyang 122000,China)

机构地区：[1]辽宁省朝阳市第二医院内分泌科,122000 [2]辽宁省朝阳市第二医院肾内科 [3]辽宁省铁岭市中心医院内分泌科 [4]河北省邯郸市第一医院内分泌一科

出　　处：《临床内科杂志》2021年第4期230-232,共3页Journal of Clinical Internal Medicine

基　　金：河北省卫生厅科研基金项目(20160341)。

摘　　要：目的探讨血液灌流联合血液透析治疗对糖尿病肾病患者的有效性及安全性。方法选择需进行血液透析的糖尿病肾病患者164例,随机分为观察组(82例)和对照组(82例),观察组患者接受血液灌流联合血液透析疗法,对照组患者接受血液透析疗法。收集并比较两组患者的一般资料、治疗前后血液中炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、β_(2)微球蛋白(β_(2)-MG)]、糖化血红蛋白(HbA1c)、血肌酐(SCr)、胰岛素抵抗情况[空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]及营养水平[BMI、前白蛋白(PA)、白蛋白(Alb)、肱三头肌皮褶厚度(TSF)、患者主观整体营养状况评量表(PG-SGA)评分]。统计两组患者治疗后并发症的发生情况。结果治疗后,两组患者TNF-α、IL-6、hs-CRP、SCr、FPG、FINS水平及HOMA-IR均明显低于同组治疗前,PA、Alb、BMI、TSF及PG-SGA评分均明显高于同组治疗前;观察组患者hs-CRP、β_(2)-MG、SCr、FPG、FINS、HOMA-IR水平均明显低于对照组治疗后,PA、Alb、BMI、TSF水平及PG-SGA评分均明显高于对照组治疗后(P<0.05)。治疗后观察组患者并发症发生率明显低于对照组(P=0.005)。结论血液灌流联合血液透析疗法能够使糖尿病肾病患者体内的微炎症情况、胰岛素抵抗、营养不良状态等得到改善,且并发症较少,对于糖尿病肾病的治疗具有较好的有效性和安全性。Objective To investigate the safety and effectiveness of hemoperfusion combined with hemodialysis in patients with diabetic nephropathy.Methods The 164 cases of diabetic nephropathy requiring hemodialysis were randomly divided into observation group(82 cases)and control group(82 cases).The observation group was treated with hemoperfusion combined with hemodialysis,and the control group was treated with hemodialysis method.The clinical data,blood inflammatory factors[tumor necrosis factor(TNF)-α,interleukin(IL)-6,high sensitivity C-reactive protein(hs-CRP),β_(2)microglobulin(β_(2)-MG)],glycosylated hemoglobin(HbA1c),serum creatinine(SCr),insulin resistance[fasting plasma glucose(FPG),fasting insulin(FINS),insulin resistance index(HOMA-IR)]and nutritional levels[BMI,pre-albumin(PA),albumin(Alb),triceps skin pleat thickness(TSF),patient-generated subjective global assessment(PG-SGA)scores]before and after treatment were collected and compared between the two groups.The incidence of complications after treatment in the two groups were statistically analyzed.Results After treatment,the levels of TNF-α,IL-6,hs-CRP,SCr,FPG,FINS and HOMA-IR were significantly lower than those before treatment in the two groups,while PA,Alb,BMI,TSF and PG-SGA were significantly higher than those before treatment;the levels of hs-CRP,β_(2)-MG,SCr,FPG,FINS and HOMA-IR in the observation group were significantly lower than those in the control group,while the levels of PA,Alb,BMI,TSF,PG-SGA scores were significantly higher than those in the control group(P<0.05).After treatment,the incidence of complications in the observation group was significantly lower than that in the control group(P=0.005).Conclusion Hemoperfusion combined with hemodialysis can improve the microinflammation,insulin resistance and malnutrition in diabetic nephropathy patients,with fewer complications,and has good effectiveness and safety for the treatment of diabetic nephropathy.

关 键 词：血液灌流 血液透析 糖尿病肾病 有效性 安全性 

分 类 号：R587.1[医药卫生—内分泌]