三种不同血液净化模式对糖尿病肾病终末期患者营养状况、胰岛素抵抗的影响  

Effects of three different blood purification modes on nutritional status and insulin resistance in patients with end-stage diabetes nephropathy

作　　者：张烨[1] 杨文君[1] 何帆[1] 王顺[1] Zhang Ye;Yang Wenjun;He Fan;Wang Shun(Department of Nephropathy,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院肾病三科,乌鲁木齐830011

出　　处：《中国医师进修杂志》2024年第12期1072-1076,共5页Chinese Journal of Postgraduates of Medicine

基　　金：国家自然科学基金(81960132)。

摘　　要：目的观察三种不同血液净化模式对糖尿病肾病(DN)终末期患者营养状况、胰岛素抵抗的影响。方法回顾性选取2019年1月至2022年1月新疆医科大学第一附属医院收治的150例DN终末期患者,按治疗方法的不同分为三组,每组50例,A组采用高通量血液透析治疗,B组采用序贯血液透析治疗,C组采用血液透析联合血液灌流治疗。治疗3个月后评估三组患者营养状况、胰岛素抵抗、炎性因子水平及不良反应发生情况。结果C组治疗后前白蛋白、白蛋白水平高于A、B组[(328.19±34.82)mg/L比(241.87±23.75)、(246.35±24.06)mg/L,(36.82±9.51)g/L比(30.07±8.73)、(29.54±8.14)g/L],差异有统计学意义(P<0.05)。C组治疗后空腹胰岛素、空腹血糖及稳态模型评估法胰岛素抵抗指数水平低于A、B组[(6.82±1.46)mU/L比(8.79±1.1)、(8.34±1.08)mU/L,(7.57±1.13)mmol/L比(9.51±1.25)、(9.28±1.21)mmol/L,2.29±0.75比4.11±0.84、3.81±0.79],差异有统计学意义(P<0.05)。C组治疗后血清白细胞介素6、高敏C反应蛋白、肿瘤坏死因子-α水平低于A、B组[(9.28±2.96)μg/L比(16.34±3.13)、(17.52±4.08)μg/L,(5.17±1.1)mg/L比(7.81±1.25)、(7.36±1.21)mg/L,(36.06±4.7)ng/L比(42.07±5.84)、(43.23±5.79)ng/L],差异有统计学意义(P<0.05)。A、B、C组总不良反应发生率分别为20.00%(10/50)、16.00%(8/50)、4.00%(2/50),三组总不良反应发生率比较差异有统计学意义(χ^(2)=6.31,P=0.043)。结论与高通量血液透析、序贯血液透析治疗比较,针对DN终末期患者采取血液透析联合血液灌流治疗能有效改善患者机体营养状况,降低患者血糖水平,减轻胰岛素抵抗和微炎性反应状态,并且能减少不良反应。ObjectiveTo observe the effects of three different blood purification modes on nutritional status and insulin resistance in patients with end-stage diabetes nephropathy(DN).MethodsFrom January 2019 to January 2022,150 patients with end-stage DN admitted to the First Affiliated Hospital of Xinjiang Medical University were retrospectively selected.All patients were divided into three groups according the treatment methods,the group A was treated with high-throughput hemodialysis,the group B was treated with sequential hemodialysis,the group C was treated with hemodialysis combined with hemoperfusion,with 50 patients in each group.After 3 months of treatment with different blood purification modes,the nutritional status,insulin resistance,inflammatory factors and adverse reactions of the patients in the three groups were evaluated.ResultsAfter treatment,the levels of serum prealbumin(PA)and albumin(ALB)in the group C were higher than those in the group A and group B:(328.19±34.82)mg/L vs.(241.87±23.75),(246.35±24.06)mg/L;(36.82±9.51)g/L vs.(30.07±8.73),(29.54±8.14)g/L,there were statistical differences(P<0.05).After treatment,the levels of fasting insulin(FINS),fasting blood glucose(FBG)and homeostatic model assessment insulin resistance index(HOMA-IR)in the group C were lower than those in the group A and group B:(6.82±1.46)mU/L vs.(8.79±1.1),(8.34±1.08)mU/L;(7.57±1.13)mmol/L vs.(9.51±1.25),(9.28±1.21)mmol/L;2.29±0.75 vs.4.11±0.84,3.81±0.79,there were statistical differences(P<0.05).After treatment,the levels of interleukin-6(IL-6)and high-sensitivity C-reactive protein(hs-CRP)in the group C were lower than those in the group A and group B:(9.28±2.96)μg/L vs.(16.34±3.13),(17.52±4.08)μg/L;(5.17±1.1)mg/L vs.(7.81±1.25),(7.36±1.21)mg/L;(36.06±4.7)ng/L vs.(42.07±5.84),(43.23±5.79)ng/L,there were statistical differences(P<0.05).After treatment,the rate of adverse reactions in the group A,group B and group C was 20.00%(10/50),16.00%(8/50),4.00%(2/50),there was statistical difference(χ^(2)=6.31,

关 键 词：糖尿病肾病 高通量血液透析 序贯血液透析 血液灌流 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]