序贯血液透析滤过结合血液灌流治疗糖尿病肾病维持性血液透析的效果分析

Effect analysis of sequential hemodiafiltration combined with hemoperfusion on maintenance hemodialysis patients with diabetic nephropathy

摘要:

目的 探讨序贯血液透析滤过结合血液灌流治疗糖尿病肾病维持性血透患者的效果。方法 选取2018年3月—2019年3月恩施州中心医院收治的糖尿病肾病维持性血透患者98例作为研究对象。根据不同治疗方法分为观察组和对照组，每组49例。观察组采用序贯血液透析滤过结合血液灌流治疗；对照组采用序贯血液透析滤过单独治疗。比较两组患者治疗前后血糖指标、胰岛素相关指标、脂肪因子及炎症因子水平变化。结果 治疗1个疗程后观察组的空腹血糖、餐后2 h血糖低于对照组（P <0.05），糖化血红蛋白高于对照组（P <0.05），胰岛素抵抗指数、空腹胰岛素水平及胰岛素用量低或少于对照组（P <0.05），抵抗素水平低于对照组（P <0.05），脂联素水平高于对照组（P <0.05），肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）水平低于对照组（P <0.05）。结论 应用序贯血液透析滤过结合血液灌流可有效控制糖尿病肾病维持性血液透析患者血糖，改善胰岛素抵抗现象，调节血清脂肪因子和炎症因子水平。

Abstract:

Objective To investigate the effect of sequential hemodiafiltration combined with hemoperfusion on patients with diabetic nephropathy and maintenance hemodialysis.Methods Totally 98 patients with diabetic nephropathy maintenance hemodialysis who were treated from March 2018 to March 2019 were selected as the subjects of this study. According to the simple random grouping method, the study subjects were divided into observation group (49 cases) and control group (49 cases). The control group was treated with sequential hemodiafiltration, and the observation group was treated with sequential hemodiafiltration combined with hemoperfusion. The Changes in blood glucose, insulin-related indicators, adipokines, and inflammatory factors were compared between the two groups of patients before and after treatment.Results The fasting blood glucose and 2 h postprandial blood glucose of the observation group after treatment were lower than those of the control group, and the glycated hemoglobin of the observation group after 1 course of treatment was higher than that of the control group (P < 0.05). The observation group had lower insulin resistance index, fasting insulin level, and insulin dosage after one course of treatment than the control group (P < 0.05). The resistin in the observation group after one course of treatment was lower than that in the control group, and the adiponectin level in the observation group was higher than that of the control group after one course of treatment (P < 0.05). The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP) in the observation group were lower than those in the control group after 1 course of treatment (P < 0.05).Conclusion In the treatment of patients with diabetic nephropathy and maintenance hemodialysis, the application of sequential hemodiafiltration combined with hemoperfusion can effectively control patients' blood glucose, improve insulin resistance, and regulate the levels of adipokines and inflammatory factors in serum.