高通量血液透析对糖尿病肾病患者生存率的影响研究
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摘要
目的观察高通量血液透析对糖尿病肾病患者生存率的影响。方法选取定安人民医院2014年4月-2015年4月收治的糖尿病肾病患者80例,按透析通量将其分为高通量组和低通量组,各40例,两组患者均实施常规治疗,其中低通量组给予低通量血液透析,高通量组给予高通量血液透析,两组透析频次:4 h/次,3次/周,透析时间:6个月。两组患者透析半年后观察透析效果,包括:肾功能指标[血尿素氮(BUN)、血清肌酐(Scr)]、糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hFPG)]及炎症指标[血β2-微球蛋白(β2-MG)、超敏C反应蛋白(hs-CRP)],并对两组患者实施为期3年随访调查,观察1年、3年生存率。结果透析半年后,高通量组BUN、FPG、2hFPG、β2-MG、hs-CRP水平均低于低通量组,Scr水平高于低通量组(P<0.05)。透析1年,高通量组和低通量组生存率间差异无统计学意义(P>0.05);透析3年,高通量组生存率72.50%,高于低通量组50.00%,差异有统计学意义(P<0.05)。结论糖尿病肾病患者采用高通量血液透析能提高血液透析效果,改善患者肾功能,同时提高3年生存率。
Objective To observe the 1-year and 3-year survival rates of high-flux hemodialysis in patients with diabetic nephropathy.Methods Eighty patients with diabetic nephropathy admitted to our hospital between April 2014 and April 2015 were enrolled. According to the dialysis flux,these patients were divided into the high-flux group and low-flux group,with 40 cases in each group. The two groups were given routine treatment,but the low-flux group was given low-flux hemodialysis,while the highflux group was given high-flux hemodialysis. The dialysis frequency of the two groups was 4 h/time,3 times/wk,and dialysis lasted 6 months. The dialysis effects were observed after six-month dialysis in the two groups,involving renal function indicators[blood urea nitrogen(BUN),serum creatinine(Scr) ],glucose metabolism indexes[fasting plasma glucose(FPG),2-hour fasting plasma glucose(2hFPG) ]and inflammatory markers [β2-microglobulin(β2-MG),and hypersensitive C-reactive protein(hs)-CRP) ]. A three-year follow-up survey was performed on the two groups,and the 1-year and 3-year survival rates were observed.Results After six months of dialysis,the BUN,FPG,2 h FPG,β2-MG and hs-CRP levels in the high-flux group were lower than those in the low-flux group,but the Scr level was higher than that in the low-flux group(P<0.05). After one year of dialysis,the survival rates in the two groups were comparable(P>0.05). After three years of dialysis,the survival rate in the high-flux group was higher than that in the low-flux group(72.50% vs 50.00%)(P<0.05).Conclusion High-flux hemodialysis for patients with diabetic nephropathy can improve hemodialysis effects and renal function,and enhance the three-year survival rate.
Objective To observe the 1-year and 3-year survival rates of high-flux hemodialysis in patients with diabetic nephropathy.Methods Eighty patients with diabetic nephropathy admitted to our hospital between April 2014 and April 2015 were enrolled. According to the dialysis flux,these patients were divided into the high-flux group and low-flux group,with 40 cases in each group. The two groups were given routine treatment,but the low-flux group was given low-flux hemodialysis,while the highflux group was given high-flux hemodialysis. The dialysis frequency of the two groups was 4 h/time,3 times/wk,and dialysis lasted 6 months. The dialysis effects were observed after six-month dialysis in the two groups,involving renal function indicators[blood urea nitrogen(BUN),serum creatinine(Scr) ],glucose metabolism indexes[fasting plasma glucose(FPG),2-hour fasting plasma glucose(2hFPG) ]and inflammatory markers [β2-microglobulin(β2-MG),and hypersensitive C-reactive protein(hs)-CRP) ]. A three-year follow-up survey was performed on the two groups,and the 1-year and 3-year survival rates were observed.Results After six months of dialysis,the BUN,FPG,2 h FPG,β2-MG and hs-CRP levels in the high-flux group were lower than those in the low-flux group,but the Scr level was higher than that in the low-flux group(P<0.05). After one year of dialysis,the survival rates in the two groups were comparable(P>0.05). After three years of dialysis,the survival rate in the high-flux group was higher than that in the low-flux group(72.50% vs 50.00%)(P<0.05).Conclusion High-flux hemodialysis for patients with diabetic nephropathy can improve hemodialysis effects and renal function,and enhance the three-year survival rate.
引文
[1]梁虹,高海娥,李飞,等.糖尿病肾病尿毒症患者尿路感染危险因素分析与预防[J].中华医院感染学杂志,2016,26(5):1056.
[2]夏敏,张萍,盛凯翔,等.老年终末期肾病患者血液透析和腹膜透析的预后分析[J].中华肾脏病杂志,2016,32(8):584.
[3]华瑞芳,刘勇,曾小兵,等.2型糖尿病肾病血液透析患者感染病原菌分布及对肾功能影响的研究[J].中华医院感染学杂志,2016,26(13):2985.
[4]赖玮婧,刘芳,付平.慢性肾脏病评估及管理临床实践指南解读-从K/DOQI到KDIGO[J].中国实用内科杂志,2013,33(6):448.
[5]徐守伟,刘冰冰,范刚.对糖尿病诊断标准的几点建议[J].山东医药,2007,47(14):62.
[6]胡志娟,张霄鹏,高占红,等.糖尿病肾病和非糖尿病肾病血液透析患者餐后胃促生长素水平与胃轻瘫的相关性[J].中国老年学杂志,2018,38(11):2604.
[7]金鑫,于泽莺,阿丽娅.高通量透析在终末期糖尿病肾病中的临床应用[J].实用医学杂志,2016,32(13):2250.
[8]公超,徐岩.高通量透析对维持性血液透析患者营养状况及牙周炎的影响[J].中国组织工程研究,2018,22(18):2884.
[9]刘莉,牛世慧,刘名鑫,等.高通量血液透析对尿毒症患者肾功能改善及血清PTH、hs-CRP水平的影响[J].中国地方病防治杂志,2017,32(8):914.
[10]范一超,顾自强,薛应斌,等.超纯透析联合高通量透析对血液透析患者微炎症状态及生存质量的影响[J].重庆医学,2016,45(25):3538.
[11]谢平.高通量血液透析对糖尿病肾病患者的微炎症与氧化应激相关因子的作用[J].临床和实验医学杂志,2016,15(5):462.
[12]ABE M,OKADA K,MARUYAMA T,INOSHITA A,et al.Clinical evaluation of plasma insulin and C-peptide levels with 3 different high-flux dialyzers in diabetic patients on hemodialysis[J].Int J Artif Organs,2008,31(10):898.
[13]GOTZ A K,BOGER C A,POPAL M,et al.Effect of membrane flux and dialyzer biocompatibility on survival in end-stage diabetic nephropathy[J].Nephron Clin Pract,2008,109(3):c154.
[14]GUTZWILLER J P,SCHNEDITZ D,HUBER A R,et al.Estimating phosphate removal in haemodialysis:an additional tool to quantify dialysis dose[J].Nephrol Dial Transplant,2002,17(6):1037.
[15]杨小华,韩晓骏,严冲.高通量血液透析对糖尿病肾病血液透析患者预后的影响[J].实用医学杂志,2012,28(12):2009.
[16]班遵浦,罗国鸿,陈彤.高通量透析的效果及对患者生存率的影响[J].中国现代医学杂志,2017,27(11):125.
[2]夏敏,张萍,盛凯翔,等.老年终末期肾病患者血液透析和腹膜透析的预后分析[J].中华肾脏病杂志,2016,32(8):584.
[3]华瑞芳,刘勇,曾小兵,等.2型糖尿病肾病血液透析患者感染病原菌分布及对肾功能影响的研究[J].中华医院感染学杂志,2016,26(13):2985.
[4]赖玮婧,刘芳,付平.慢性肾脏病评估及管理临床实践指南解读-从K/DOQI到KDIGO[J].中国实用内科杂志,2013,33(6):448.
[5]徐守伟,刘冰冰,范刚.对糖尿病诊断标准的几点建议[J].山东医药,2007,47(14):62.
[6]胡志娟,张霄鹏,高占红,等.糖尿病肾病和非糖尿病肾病血液透析患者餐后胃促生长素水平与胃轻瘫的相关性[J].中国老年学杂志,2018,38(11):2604.
[7]金鑫,于泽莺,阿丽娅.高通量透析在终末期糖尿病肾病中的临床应用[J].实用医学杂志,2016,32(13):2250.
[8]公超,徐岩.高通量透析对维持性血液透析患者营养状况及牙周炎的影响[J].中国组织工程研究,2018,22(18):2884.
[9]刘莉,牛世慧,刘名鑫,等.高通量血液透析对尿毒症患者肾功能改善及血清PTH、hs-CRP水平的影响[J].中国地方病防治杂志,2017,32(8):914.
[10]范一超,顾自强,薛应斌,等.超纯透析联合高通量透析对血液透析患者微炎症状态及生存质量的影响[J].重庆医学,2016,45(25):3538.
[11]谢平.高通量血液透析对糖尿病肾病患者的微炎症与氧化应激相关因子的作用[J].临床和实验医学杂志,2016,15(5):462.
[12]ABE M,OKADA K,MARUYAMA T,INOSHITA A,et al.Clinical evaluation of plasma insulin and C-peptide levels with 3 different high-flux dialyzers in diabetic patients on hemodialysis[J].Int J Artif Organs,2008,31(10):898.
[13]GOTZ A K,BOGER C A,POPAL M,et al.Effect of membrane flux and dialyzer biocompatibility on survival in end-stage diabetic nephropathy[J].Nephron Clin Pract,2008,109(3):c154.
[14]GUTZWILLER J P,SCHNEDITZ D,HUBER A R,et al.Estimating phosphate removal in haemodialysis:an additional tool to quantify dialysis dose[J].Nephrol Dial Transplant,2002,17(6):1037.
[15]杨小华,韩晓骏,严冲.高通量血液透析对糖尿病肾病血液透析患者预后的影响[J].实用医学杂志,2012,28(12):2009.
[16]班遵浦,罗国鸿,陈彤.高通量透析的效果及对患者生存率的影响[J].中国现代医学杂志,2017,27(11):125.