高通量血液透析对2型糖尿病肾病患者毒素清除和炎症因子、氧化应激因子水平的影响
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摘要
目的探究高通量血液透析(HFHD)对2型糖尿病肾病(DN)患者毒素清除和炎症因子、氧化应激因子水平的影响。方法采用计算机随机数字法将2016年1月至2018年1月我院收治的96例DN患者分为观察组和对照组各48例。观察组患者予以HFHD治疗,对照组患者予以低通量血液透析(LFHD)治疗。比较两组患者血清小分子毒素[血肌酐(SCr)、血尿素、血尿酸、血磷]、中分子及大分子毒素[甲状旁腺素(PTH)、视黄醇结合蛋白(RBP)、血清β_2微球蛋白(β_2-MG)、半胱氨酸蛋白酶抑制剂(CysC)]清除效果,观察治疗前、治疗6个月后血清炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]、氧化应激因子[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]水平变化情况。结果治疗6个月后,两组患者SCr、血尿素、血尿酸、血磷以及血清PTH、RBP、β_2-MG、CysC水平均较治疗前降低(P<0. 05),且观察组血尿酸、血磷以及血清PTH、RBP、β_2-MG、CysC水平均低于对照组(P<0.05);观察组患者血清IL-6、CRP、TNF-α、MDA水平均较治疗前降低,且低于对照组(P <0. 05),SOD、GSH-Px水平较治疗前升高,且高于对照组(P <0. 05),对照组患者治疗前后上述指标比较,差异无统计学意义(P>0.05)。结论 HFHD可有效清除DN患者血液中的毒素,减轻机体炎症反应并改善氧化应激水平。
Objective To explore the effects of high-flux hemodialysis(HFHD) on toxin clearance and levels of inflammatory factors and oxidative stress factors in patients with type 2 diabetic nephropathy( DN).Methods 96 cases of patients with DN admitted to our hospital from January,2016 to January,2018 were divided into the observation group and the control group by random number method, with 48 cases in each group. The observation group was given HFHD, and the control group was given low-flux hemodialysis(LFHD).The clearance effects of serum micromolecule toxins [ serum creatinine(SCr),blood urea,blood uric acid, blood phosphorus], medium molecular and macromolecular toxins [parathyroid hormone(PTH),retinol binding protein(RBP), serum β2 microglobulin(β_2-MG) and cysteine proteinase inhibitors(CysC)]were compared between the two groups. The levels of serum inflammatory factors [ interleukin-6(IL-6),C-reaction protein(CRP), tumor necrosis factor-α(TNF-α) ] and oxidative stress factors [ malondialdehyde(MDA), superoxide dismutase(SOD), glutathione peroxidase( GSH-Px) ] were observed before treatment and after 6 months of treatment. Results After 6 months of treatment,the levels of SCr,blood urea,blood uric acid,blood phosphorus and serum PTH,RBP,β_2-MG and CysC in the two groups were lower than those of pre-treatment(P < 0. 05),and the levels of blood uric acid, blood phosphorus,and serum PTH,RBP,β_2-MG and CysC in the observation group were lower than those in the control group(P < 0.05). The levels of serum IL-6,CRP,TNF-α and MDA in the observation group were lower than those of pre-treatment, and were lower than those in the control group(P <0.05),and the levels of SOD and GSH-Px were higher than those of pre-treatment, and were higher than those in the control group(P <0. 05). There were no significant differences among the above indexes in the control group before and after treatment(P > 0. 05). Conclusion HFHD can effectively remove toxins from the blood of DN patients, reduce the body ' s inflammatory response and improve the oxidative stress level.
Objective To explore the effects of high-flux hemodialysis(HFHD) on toxin clearance and levels of inflammatory factors and oxidative stress factors in patients with type 2 diabetic nephropathy( DN).Methods 96 cases of patients with DN admitted to our hospital from January,2016 to January,2018 were divided into the observation group and the control group by random number method, with 48 cases in each group. The observation group was given HFHD, and the control group was given low-flux hemodialysis(LFHD).The clearance effects of serum micromolecule toxins [ serum creatinine(SCr),blood urea,blood uric acid, blood phosphorus], medium molecular and macromolecular toxins [parathyroid hormone(PTH),retinol binding protein(RBP), serum β2 microglobulin(β_2-MG) and cysteine proteinase inhibitors(CysC)]were compared between the two groups. The levels of serum inflammatory factors [ interleukin-6(IL-6),C-reaction protein(CRP), tumor necrosis factor-α(TNF-α) ] and oxidative stress factors [ malondialdehyde(MDA), superoxide dismutase(SOD), glutathione peroxidase( GSH-Px) ] were observed before treatment and after 6 months of treatment. Results After 6 months of treatment,the levels of SCr,blood urea,blood uric acid,blood phosphorus and serum PTH,RBP,β_2-MG and CysC in the two groups were lower than those of pre-treatment(P < 0. 05),and the levels of blood uric acid, blood phosphorus,and serum PTH,RBP,β_2-MG and CysC in the observation group were lower than those in the control group(P < 0.05). The levels of serum IL-6,CRP,TNF-α and MDA in the observation group were lower than those of pre-treatment, and were lower than those in the control group(P <0.05),and the levels of SOD and GSH-Px were higher than those of pre-treatment, and were higher than those in the control group(P <0. 05). There were no significant differences among the above indexes in the control group before and after treatment(P > 0. 05). Conclusion HFHD can effectively remove toxins from the blood of DN patients, reduce the body ' s inflammatory response and improve the oxidative stress level.
引文
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[13]刘苑苹,包蓓艳,李国富,等.葛根素对老年糖尿病肾病伴微量蛋白尿患者氧化应激损伤和血清炎症因子的影响[J].中国老年学杂志,2018,38(7):1578-1580.
[14]唐丹,张剑彬,陈莉,等.前列地尔对2型糖尿病肾病患者氧化应激损伤的影响[J].重庆医学,2018,47(17):2369-2371.
[15]周瑾,郭风玲,黄兰,等.左卡尼汀注射液联合生血宁片治疗糖尿病肾病腹膜透析伴肾性贫血的临床研究[J].中国临床药理学杂志,2018,34(2):105-107,130.
[2]曹小会,贾丽艳,胡艳云,等.血液灌流联合序贯透析对糖尿病肾病患者可溶性肿瘤坏死因子受体的影响[J].海南医学院学报,2018,24(1):23-25,29.
[3]张红霞,王贵霞,李振翮,等.不同血液透析方式对非糖尿病肾病透析患者胰岛素抵抗的影响[J].重庆医学,2017,46(29):4081-4084.
[4]林果为,王吉耀,葛均波.实用内科学[M].第15版.北京:人民卫生出版社,2017:1956-1961.
[5]修静.血液灌流联合血液透析治疗终末期糖尿病肾病的疗效研究[J].中国急救医学,2017,37(Suppl 2):163-164.
[6]马玲,云鹏.血液透析与血液灌流疗法改善糖尿病肾病透析者微炎症状态的作用[J].重庆医学,2017,46(6):767-769.
[7]马志宏,胡文博,贾顺莲,等.高通量与低通量血液透析对糖尿病肾病透析患者氧化应激、细胞免疫功能和微炎症状态的影响[J].现代生物医学进展,2017,17(30):5963-5966.
[8]许建国,赵红,谢胜,等.高通量透析联合左卡尼汀对血液透析患者微炎症状态的影响[J].中国急救医学,2017,37(Suppl 2):68-69.
[9]赵金香,李耀华,谢萍,等.黄葵胶囊对糖尿病肾病血液透析患者微炎症和氧化应激状态的影响[J].中国中医药信息杂志,2017,24(2):21-24.
[10]沈文,陈兰英,肖志娟,等.左乙拉西坦对癫痫患者氧化应激及炎性因子的影响[J].成都医学院学报,2017,12(6):694-698.
[11]宋霖,张宁.糖尿病肾病患者尿液白细胞介素-6与肿瘤坏死因子-α检测的临床意义[J].检验医学与临床,2017,14(3):348-349.
[12]杨静,蒋文勇,于黔,等.高通量血液透析对糖尿病肾病维持性血液透析患者氧化应激和微炎症状态的影响[J].广东医学,2016,37(18):2784-2786.
[13]刘苑苹,包蓓艳,李国富,等.葛根素对老年糖尿病肾病伴微量蛋白尿患者氧化应激损伤和血清炎症因子的影响[J].中国老年学杂志,2018,38(7):1578-1580.
[14]唐丹,张剑彬,陈莉,等.前列地尔对2型糖尿病肾病患者氧化应激损伤的影响[J].重庆医学,2018,47(17):2369-2371.
[15]周瑾,郭风玲,黄兰,等.左卡尼汀注射液联合生血宁片治疗糖尿病肾病腹膜透析伴肾性贫血的临床研究[J].中国临床药理学杂志,2018,34(2):105-107,130.