摘要
目的研究高通血液透析(HFHD)联合生血宁对维持性血液透析(MHD)老年患者肾性贫血及氧化应激的影响。方法选取2017年1月至2019年12月于阜阳市第二人民医院治疗的老年MHD肾性贫血患者100例,随机分为观察组和对照组,各50例。所有患者均采用HFHD,同时给予重组人促红素(rHuEPO)皮下注射,在此基础上观察组和对照组分别给予生血宁和琥珀酸亚铁片口服,疗程3个月。比较2组治疗前后贫血状态[血红蛋白(Hb)、血细胞比容(Hct)和血清铁蛋白(SF)]、营养水平[白蛋白(Alb)、转铁蛋白(TRF)、血清总蛋白(TP)]、微炎症状态[高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子(TNF-α)]、氧化应激水平[血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)]、心血管指标[B型脑钠肽(BNP)、平均动脉压(MAP)、血管外肺水指数(EVLWI)]和肝肾功能[血肌酐(Scr)、β2微球蛋白(β2-MG)、谷丙转氨酶(ALT)]变化,同时观察药物不良反应发生情况。结果与治疗前相比,治疗后2组Hb、Hct和SF水平均明显升高(P<0.05),但2组间比较各指标差异无统计学意义(P>0.05)。与治疗前相比,治疗后观察组ALB、TRF和TP水平明显升高(P<0.05),对照组各指标无明显变化(P>0.05),且观察组治疗后ALB、TRF和TP水平高于对照组,差异有统计学意义(P<0.05)。与治疗前相比,治疗后2组hs-CRP、IL-6和TNF-α水平均明显降低(P<0.05),且观察组hs-CRP、IL-6和TNF-α水平低于对照组,差异有统计学意义(P<0.05)。与治疗前相比,治疗后2组SOD和GSH-Px水平均明显升高(P<0.05),MDA水平明显降低(P<0.05),且观察组治疗后SOD和GSH-Px水平高于对照组,MDA水平低于对照组,差异有统计学意义(P<0.05)。与治疗前相比,治疗后2组BNP水平明显降低(P<0.05),MAP和EVLWI均未见明显变化(P>0.05),且观察组治疗后BNP水平低于对照组,差异有统计学意义(P<0.05)。与治疗前相比,治疗后2组Scr和β2-MG水平均明显降低(P<0.05),ALT水平未见明显变化(P>0.05),2组间比较各指标差异无统计学意义(P>0.05)。观察组肺部感染(4.35%vs8.51%)、消化道不适发生率(6.52%vs21.28%)均低于对照组,差异有统计学意义(P<0.05)。结论HFHD联合生血宁治疗老年MHD患者肾性贫血可有效改善患者贫血状态、营养水平、微炎症状态和氧化应激,对防止心血管疾病发生具有积极作用,临床效果和安全性均值得肯定。
ObjectiveTo investigate the effects of high-flux hemodialysis(HFHD)combined with Shengxuening on renal anemia and oxidative stress in elderly patients with maintenance hemodialysis(MHD).MethodsA total of 100 elderly patients with MHD and renal anemia who were treated at Fuyang Second People's Hospital from January 2017 to December 2019 were randomly divided into an observation group and a control group,with 50 cases each.They were all treated with HFHD,and human erythropoietin(rHuEPO)was injected subcutaneously.On this basis,the observation group and the control group were orally given Shengxuening and ferrous succinate tablets,respectively,and the course of treatment was 3 months.The anemia status[hemoglobin(Hb),hematocrit(Hct),and serum ferritin(SF)],nutritional level[albumin(Alb),transferrin(TRF),and total serum protein(TP)],micro-inflammatory state[high sensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)],oxidative stress level[serum superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),and serum malondialdehyde(MDA)],cardiovascular indicators[B-type brain natriuretic peptide(BNP),mean arterial pressure(MAP),and extravascular lung water index(EVLWI)],and liver and kidney function[creatinine(Scr),β2 microglobulin(β2-MG),and alanine aminotransferase(ALT)]were compared between the two groups,and the occurrence of adverse drug reactions was observed.ResultsAfter treatment,the levels of Hb,Hct,and SF in the two groups were significantly increased compared with those before treatment(P<0.05),but there was no statistical significance in each index between the two groups(P>0.05).The levels of ALB,TRF,and TP in the observation group were significantly increased after treatment(P<0.05),while no significant changes were observed in the control group(P>0.05);the levels of ALB,TRF,and TP in the observation group were higher than those in the control group(P<0.05).The levels of hS-CRP,IL-6,and TNF-αin both groups were significantly decreased after treatment(P<0.05),and the levels of hS-CRP,IL-6,and TNF-αin the observation group were significantly lower than those in the control group(P<0.05).SOD and GSH-Px levels in both groups were significantly increased after treatment(P<0.05),while MDA levels were significantly decreased(P<0.05).SOD and GSH-Px levels in the observation group were significantly higher than those in the control group,while MDA level was significantly lower than that in the control group(P<0.05).BNP levels in both groups were significantly decreased after treatment(P<0.05),while MAP and EVLWI showed no significant changes(P>0.05);BNP level in the observation group was significantly lower than that of the control group(P<0.05).The levels of Scr andβ2-MG in both groups were significantly decreased after treatment(P<0.05),while the level of ALT was not significantly changed(P>0.05);there was no statistical significance in these indexes between the two groups(P>0.05).The incidence of pulmonary infection(4.35%vs8.51%)and digestive tract discomfort(6.52%vs21.28%)in the observation group was significantly lower than that of the control group(P<0.05).ConclusionHFHD combined with Shengxuening in the treatment of renal anemia in elderly patients with MHD can effectively improve the anemia status,nutritional level,micro-inflammatory status,and oxidative stress,which has positive effects in preventing the occurrence of cardiovascular disease.This combination therapy has appreciated clinical effects and safety.
作者
马涛
李秀勇
王丽
刘正亮
张甜甜
王瑞雪
张磊
王心亮
Ma Tao;Li Xiuyong;Wang Li;Liu Zhengliang;Zhang Tiantian;Wang Ruixue;Zhang Lei;Wang Xinliang(Blood Purification Center,No.2 People's Hospital of Fuyang City,Fuyang 236000,China;Department of Nephrology,Shenzhen Longhua New District People's Hospital,Shenzhen 515041,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2021年第12期1009-1015,共7页
Chinese Journal of Clinicians(Electronic Edition)
基金
阜阳市卫生和计划生育委员会项目(2016-49)
