摘要
目的探究序贯血液透析滤过(HDF)联合血液灌流(HP)模式对终末期肾病(ESRD)患者微炎症状态以及心血管结局的影响。方法回顾性选取2021年6月至2023年6月在东部战区总医院、南京市六合人民医院、南京市南京医科大学第四附属医院收治的ESRD患者86例,依据治疗方法不同将其分为普通血液透析(HD)组(n=25)、HDF组(n=30)以及HDF+HP组(n=31),3组均持续治疗3个月。比较3组治疗前、治疗3个月后患者微炎症状态指标[C反应蛋白(CRP)、白细胞介素(IL)-6、IL-8以及肿瘤坏死因子-α(TNF-α)]、营养指标(总蛋白、白蛋白、转铁蛋白、血红蛋白)以及钙磷代谢指标[甲状旁腺激素(iPTH)、血钙、血磷]水平的差异性,并统计患者心血管结局情况。结果治疗3个月后,HDF+HP组患者CRP、IL-6、IL-8、TNF-α、iPTH、血磷水平分别为(6.00±0.47)mg/L、(34.20±0.58)ng/mL、(17.00±1.58)ng/L、(37.25±1.20)ng/mL、(256.20±30.23)pg/L、(1.66±0.09)mmol/L,均低于HD组[(8.23±1.05)mg/L、(38.30±1.14)ng/mL、(25.13±4.00)ng/L、(42.23±1.25)ng/mL、(569.43±45.11)pg/L、(2.06±0.10)mmol/L],也低于HDF组[(7.61±0.85)mg/L、(36.00±1.00)ng/mL、(19.15±2.04)ng/L、(40.96±1.10)ng/mL、(380.69±23.10)pg/L、(1.90±0.11)mmol/L],差异均有统计学意义(P<0.05)。治疗3个月后,HDF+HP组患者总蛋白、白蛋白、转铁蛋白、血红蛋白以及血钙水平分别为(65.58±6.12)g/L、(39.74±5.00)g/L、(370.62±34.00)mg/dL、(110.15±7.30)g/L、(2.54±0.11)mmol/L,均高于HD组[(58.62±4.18)g/L、(31.67±3.67)g/L、(224.30±12.00)mg/dL、(94.90±3.15)g/L、(2.34±0.10)mmol/L],也高于HDF组[(62.00±5.47)g/L、(35.69±4.12)g/L、(304.15±23.68)g/L、(105.63±4.98)g/L、(2.40±0.10)mmol/L],差异均有统计学意义(P<0.05)。3组间心血管事件发生率比较,差异无统计学意义(P>0.05)。结论HDF联合HP模式可有效改善ESRD患者的微炎症状态与营养状况,调节其钙磷代谢,不会增加心血管事件风险,是一种安全且有效的杂合血液净化方法。
Objective To investigate the effect of sequential hemodiafiltration(HDF) combined with hemoperfusion(HP) on microinflammatory status and cardiovascular outcomes in patients with end-stage renal disease(ESRD).Methods A total of 86 ESRD patients in Eastern Theater Command General Hospital,Nanjing Liuhe People's,and the Fourth Affiliated Hospital of Nanjing Medical University Hospital from June 2021 to June 2023 were retrospectively selected.According to the different treatment methods,they were divided into ordinary hemodialysis(HD) group(n=25),HDF group(n=30) and HDF+HP group(n=31).All three groups were treated for 3 months.The microinflammatory status indicators [C-reactive protein(CRP),interleukin(IL)-6,IL-8 and tumor necrosis factor-α(TNF-α)],nutritional indicators(total protein,albumin,transferrin,hemoglobin) and calcium and phosphorus metabolic indicators [parathyroid hormone(iPTH),blood calcium,and blood phosphorus] were compared between the three groups before treatment and three months after treatment,and cardiovascular outcomes were measured.Results Three months after treatment,the levels of CRP,IL-6,IL-8,TNF-α,iPTH and blood phosphorus in the HDF+HP group were(6.00±0.47) mg/L,(34.20±0.58) ng/mL,(17.00±1.58) ng/L,(37.25±1.20) ng/mL,and(256.20±30.23) pg/L,(1.66±0.09) mmol/L,which were lower than in those in the HD group [(8.23±1.05) mg/L,(38.30±1.14) ng/mL,(25.13±4.00) ng/L,(42.23±1.25) ng/mL,(569.43±45.11) pg/L,(2.06±0.10) mmol/L],also lower than those in the HDF group [(7.61±0.85) mg/L,(36.00±1.00) ng/mL,(19.15±2.04) ng/L,(40.96±1.10) ng/mL,(380.69±23.10) pg/L,(1.90±0.11) mmol/L],the differences were statistically significant(P<0.05).Three months later,the levels of total protein,albumin,transferrin,hemoglobin and blood calcium in HDF+HP group were(65.58±6.12) g/L,(39.74±5.00) g/L,(370.62±34.00) mg/dl,(110.15±7.30) g/L,and(2.54±0.11) mmol/L,which were higher than those in the HD group [(58.62±4.18) g/L,(31.67±3.67) g/L,(224.30±12.00) mg/dl,(94.90±3.15) g/L,(2.34±0.10) mmol/L],and also higher than those in the HDF group [(62.00±5.47) g/L,(35.69±4.12) g/L,(304.15±23.68) g/L,(105.63±4.98) g/L,(2.40±0.10) mmol/L],the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of cardiovascular events among the three groups(P>0.05).Conclusion Sequential HDF combined with HP can effectively improve the microinflammatory state and nutritional status of ESRD patients,regulate calcium and phosphorus metabolism,and do not increase the risk of cardiovascular events.It is a safe and effective heterozygous blood purification method.
作者
贾美荣
张梦雅
张思源
张欢
陈烁
侯万萍
孔凌
JIA Mei-rong;ZHANG Meng-ya;ZHANG Si-yuan(Eastern Theater Command General Hospital,Blood Purification Center,National Clinical Research Center for Kidney Disease,Nanjing Jiangsu 210016,China)
出处
《临床和实验医学杂志》
2024年第7期714-718,共5页
Journal of Clinical and Experimental Medicine
基金
江苏省自然科学基金面上项目(编号:BK20151164)。
关键词
肾病
血液透析滤过
血液灌流
微炎症状态
心血管结局
Nephrosis
Hemodia filtration
Hemoperfusion
Microinflammatory state
Cardiovascular outcome
