血液透析联合血液灌流对尿毒症患儿实验室指标的影响
|
摘要
目的观察血液透析联合血液灌流对尿毒症患儿的治疗效果,以及对微小RNA-55(miR-55)、核因子-κB(NF-κB)及超敏C反应蛋白(hs-CRP)表达的影响。方法回顾性分析2016年2月至2017年9月在浙江温岭市第一人民医院接受治疗的尿毒症患儿80例的临床资料,根据其治疗方式分为血液透析组和联合治疗组(血液透析联合血液灌流组),比较两组患儿治疗前后肾功能、血常规、炎症因子和miR-55、NF-κB及hs-CRP水平的差异。结果两组患儿治疗前肾功能、血常规、炎症因子和miR-55、NF-κB及hs-CRP水平比较无明显差异,治疗后,联合治疗组患儿血尿素氮(BUN)、血肌酐(SCr)、核因子-κB(NF-κB)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、高半胱氨酸(Hcy)水平均低于血液透析组(t值分别为8.00、6.18、21.92、10.23、8.45、10.34,均P<0.05),肾小球滤过率(GFR)、miR-55、白蛋白(Alb)、血前白蛋白(PA)和血红蛋白(Hb)水平高于血液透析组(t值分别为-4.48、-3.56、-15.98、-12.78、-7.54,均P<0.05)。结论血液透析联合血液灌流对尿毒症患儿较好的治疗效果,可明显改善患儿的肾功能、miR-55、NF-κB及hs-CRP水平,具有良好的应用价值。
Objective To observe the therapeutic effect of hemodialysis combined with hemoperfusion on children with uremia and the influence on expressions of microRNA-55(miR-55), nuclear factor-κB(NF-κB) and high-sensitivity C-reactive protein(hs-CRP). Methods The clinical data of 80 uremic children treated in Wenling First People's Hospital from February 2016 to September 2017 were retrospectively analyzed. According to treatment, the cases were divided into hemodialysis group and combined treatment group(hemodialysis combining hemoperfusion group). The differences in renal function, blood routine, inflammatory factors and miR-55, NF-κB and hs-CRP were compared before and after treatment between two groups. Results There were no significant differences in renal function, blood routine, inflammatory factors, and miR-55, NF-κB, and hs-CRP levels between two groups. After treatment, blood urea nitrogen(BUN), serum creatinine, SCr, NF-κB, interleukin-6(IL-6), hs-CRP, and homocysteine(Hcy) levels of the combined treatment group were lower than those of hemodialysis group(t value was 8.00, 6.18, 21.92, 10.23, 8.45 and 10.34, respectively, all P<0.05), but glomerular filtration rate(GFR), miR-55, albumin(Alb), pre-albumin(PA) and hemoglobin(Hb) levels were higher(t value was-4.48,-3.56,-15.98,-12.78 and-7.54, respectively, all P<0.05). Conclusion Hemodialysis combined with hemoperfusion has good therapeutic effect on children with uremia, and can significantly improve renal function and the levels of miR-55, NF-κB and hs-CRP. It has good application value.
Objective To observe the therapeutic effect of hemodialysis combined with hemoperfusion on children with uremia and the influence on expressions of microRNA-55(miR-55), nuclear factor-κB(NF-κB) and high-sensitivity C-reactive protein(hs-CRP). Methods The clinical data of 80 uremic children treated in Wenling First People's Hospital from February 2016 to September 2017 were retrospectively analyzed. According to treatment, the cases were divided into hemodialysis group and combined treatment group(hemodialysis combining hemoperfusion group). The differences in renal function, blood routine, inflammatory factors and miR-55, NF-κB and hs-CRP were compared before and after treatment between two groups. Results There were no significant differences in renal function, blood routine, inflammatory factors, and miR-55, NF-κB, and hs-CRP levels between two groups. After treatment, blood urea nitrogen(BUN), serum creatinine, SCr, NF-κB, interleukin-6(IL-6), hs-CRP, and homocysteine(Hcy) levels of the combined treatment group were lower than those of hemodialysis group(t value was 8.00, 6.18, 21.92, 10.23, 8.45 and 10.34, respectively, all P<0.05), but glomerular filtration rate(GFR), miR-55, albumin(Alb), pre-albumin(PA) and hemoglobin(Hb) levels were higher(t value was-4.48,-3.56,-15.98,-12.78 and-7.54, respectively, all P<0.05). Conclusion Hemodialysis combined with hemoperfusion has good therapeutic effect on children with uremia, and can significantly improve renal function and the levels of miR-55, NF-κB and hs-CRP. It has good application value.
引文
[1]曹朕笃,李亚东,谭艳平,等.女性尿毒症患者血液透析前后心理变化[J].中国妇幼健康研究,2016,27(7):877-878.
[2]Wolfgram D,Vogt E,Jahn A L,et al.Hemodynamics during dialysis and changes in cognitive performance[J].WMJ,2016,115(6):311-316.
[3]Ertan N Z,Bozfakioglu S,Ugurel E,et al.Alterations of erythrocyte rheology and cellular susceptibility in end stage renal disease:Effects of peritoneal dialysis[J].PLoS One,2017,12(2):e0171371.
[4]Grant C,Harrison L,Hoad C,et al.Endotoxemia in peritoneal dialysis patients:A pilot study to examine the role of intestinal perfusion and congestion[J].Perit Dial Int,2017,37(1):111-115.
[5]Smogorzewski M J.Skin blood flow and vascular endothelium function in uremia[J].J Ren Nutr,2017,27(6):465-469.
[6]Charytan D M,Skali H,Shah N R,et al.Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage[J].Kidney Int,2018,93(2):501-509.
[7]Li W H,Yin Y M,Chen H,et al.Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus[J].Medicine,2017,96(12):e6160.
[8]李周,王利胜,巴文强,等.青藤碱、雷公藤甲素皮肤和血液在体微透析方法的建立[J].中草药,2015,46(14):2076-2081.
[9]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.
[10]Si X,Li J,Bi X,et al.Clinical evaluation of high-volume hemofiltration with hemoperfusion followed by intermittent hemodialysis in the treatment of acute wasp stings complicated by multiple organ dysfunction syndrome[J].PLoS One,2015,10(7):e0132708.
[11]李祥宝,乔彤.动静脉内瘘直径对非糖尿病肾病血液透析患者血压和心功能的影响[J].中华实验外科杂志,2015,32(5):1184-1186.
[12]Sandeman S R,Zheng Y,Ingavle G C,et al.A haemocompatible and scalable nanoporous adsorbent monolith synthesised using a novel lignin binder route to augment the adsorption of poorly removed uraemic toxins in haemodialysis[J].Biomed Mater,2017,12(3):035001.
[13]Assa S,Kuipers J,Ettema E,et al.Effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and left ventricular function assessed with 13N-NH3 positron emission tomography and echocardiography[J].Am J Physiol Renal Physiol,2018,314(3):F445-F452.
[14]胡志娟,王利军,史亚男,等.血浆去酰基Ghrelin水平与慢性肾脏病各期的关系[J].实用医学杂志,2017,33(13):2143-2147.
[15]Lu X,Wang S,Zhang G,et al.High neutrophil-to-lymphocyte ratio is a significant predictor of cardiovascular and all-cause mortality in patients undergoing peritoneal dialysis[J].Kidney Blood Press Res,2018,43(2):490-499.
[2]Wolfgram D,Vogt E,Jahn A L,et al.Hemodynamics during dialysis and changes in cognitive performance[J].WMJ,2016,115(6):311-316.
[3]Ertan N Z,Bozfakioglu S,Ugurel E,et al.Alterations of erythrocyte rheology and cellular susceptibility in end stage renal disease:Effects of peritoneal dialysis[J].PLoS One,2017,12(2):e0171371.
[4]Grant C,Harrison L,Hoad C,et al.Endotoxemia in peritoneal dialysis patients:A pilot study to examine the role of intestinal perfusion and congestion[J].Perit Dial Int,2017,37(1):111-115.
[5]Smogorzewski M J.Skin blood flow and vascular endothelium function in uremia[J].J Ren Nutr,2017,27(6):465-469.
[6]Charytan D M,Skali H,Shah N R,et al.Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage[J].Kidney Int,2018,93(2):501-509.
[7]Li W H,Yin Y M,Chen H,et al.Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus[J].Medicine,2017,96(12):e6160.
[8]李周,王利胜,巴文强,等.青藤碱、雷公藤甲素皮肤和血液在体微透析方法的建立[J].中草药,2015,46(14):2076-2081.
[9]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.
[10]Si X,Li J,Bi X,et al.Clinical evaluation of high-volume hemofiltration with hemoperfusion followed by intermittent hemodialysis in the treatment of acute wasp stings complicated by multiple organ dysfunction syndrome[J].PLoS One,2015,10(7):e0132708.
[11]李祥宝,乔彤.动静脉内瘘直径对非糖尿病肾病血液透析患者血压和心功能的影响[J].中华实验外科杂志,2015,32(5):1184-1186.
[12]Sandeman S R,Zheng Y,Ingavle G C,et al.A haemocompatible and scalable nanoporous adsorbent monolith synthesised using a novel lignin binder route to augment the adsorption of poorly removed uraemic toxins in haemodialysis[J].Biomed Mater,2017,12(3):035001.
[13]Assa S,Kuipers J,Ettema E,et al.Effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and left ventricular function assessed with 13N-NH3 positron emission tomography and echocardiography[J].Am J Physiol Renal Physiol,2018,314(3):F445-F452.
[14]胡志娟,王利军,史亚男,等.血浆去酰基Ghrelin水平与慢性肾脏病各期的关系[J].实用医学杂志,2017,33(13):2143-2147.
[15]Lu X,Wang S,Zhang G,et al.High neutrophil-to-lymphocyte ratio is a significant predictor of cardiovascular and all-cause mortality in patients undergoing peritoneal dialysis[J].Kidney Blood Press Res,2018,43(2):490-499.