高通量血液透析治疗对尿毒症患者心功能、微炎症因子及血清磷、全段甲状旁腺激素清除的影响

目的:分析高通量血液透析治疗尿毒症的临床价值。方法:将2016年9月至2018年9月我院收治的263例尿毒症患者按治疗方式不同分为对照组(低通量血液透析,n=121)和观察组(高通量血液透析,n=142),比较两组患者治疗前与治疗3个月后心功能左室舒张期末内径(Left ventricular end diastolic inner diameter,LVEDD)、左室收缩期末内径(End systolic diameter of left ventricle,LVESD)、左室舒张期末容积(Left ventricular end diastolic volume,LVEDV)、左室收缩期末容积(Left ventricular end systolic volume,LVESV)、左室后壁厚度(Left ventricular posterior wall thickness,LVPWT)、室间隔厚度(Interventricular septum thickness,IVST)、左室射血分数(Left ventricular ejection fraction,LVEF)、舒张早期与晚期最大血流比(E/A)及左室重量指数(Left ventricular mass index,LVMI)]、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(High sensitivity C-reactive protein,hs-CRP)、血清磷、全段甲状旁腺激素(Intact parathyroid hormone,iPTH)、B型脑钠肽(B-type brain natriuretic peptide,BNP)、心肌肌钙蛋白(Cardiac troponin,eTnT)水平、生活质量(采用简明健康检查量表(SF-36)评价)和并发症。结果:与治疗前相比,两组LVPWT、IVST、BNP、eTnT等水平均明显降低,观察组下降程度更明显(P<0.05);观察组较治疗前LVMI明显下降,LVEF显著上升(P<0.05);与治疗前相比,两组磷、iPTH、TNF-α、hs-CRP水平均明显下降,且观察组上述指标下降程度明显大于对照组(P<0.05);对照组SF-36评分明显低于观察组,不良反应总发生率明显高于观察组(P<0.05)。结论:高通量血液透析治疗尿毒症患者可一定程度上改善其心功能,降低磷、iPTH、TNF-α、hs-CRP水平,安全可靠,能有效提高患者生活质量。

Effect of high-flux hemodialysis treatment on cardiac function,micro-inflammatory factors,serum phosphorus and total parathyroid hormone clearance in patients with uremia

Objective:To analyze the clinical values of high flux hemodialysis in the treatment of uremia.Methods:A total of 263 patientswithuremia admitted to this hospital from September 2016 to September 2018 were divided into control group(low-flux hemodialysis,n=121)and observation group(high-flux hemodialysis,n=142)according to different treatments.The cardiac function Left ventricular end diastolic inner diameter(LVEDD),End systolic diameter of left ventricle(LVESD),left ventricle Left ventricular end diastolic volume(LVEDV),Left ventricular end systolic volume(LVESV),Left ventricular posterior wall thickness(LVPWT) Interventricular septum thickness(IVST),Left ventricular ejection fraction,LVEF),the ratio of the maximum blood flow between early and late diastole(E/A)and left ventricular mass index(Left ventricular mass index,LVMI)],Tumor necrosis factor-α(TNF-α),high sensitivity C-reactive protein(hs-CRP),serum phosphorus,Intact parathyroid hormone(iPTH),B-type brain natriuretic peptide(BNP),cardiac troponin(eTnT)levels],quality of life(evaluated by the Concise Health Check Scale(SF-36))and complications between the two groups before treatment and 3 months after treatment was compared.Results:Compared with those before treatment,the levels of LVPWT,IVST,BNP,eTnT,etc.in the two groups significantly reduced,and the declining in the observation group was more significant(P<0.05).Compared with those before treatment,LVMI decreased significantly,and LVEF increased significantly(P<0.05).Compared with those before treatment,the levels of phosphorus,iPTH,TNF-α,and hs-CRP in the two groups decreased significantly,and the decline in the above indicators in the observation group was significantly more than that in the control group(P<0.05).The SF-36 score of the control group was significantly lower than that of the observation group,and the total incidence of adverse reactions was significantly higher than that of the observation group(P<0.05).Conclusion:High-throughput hemodialysis can improve the cardiac function of patients with uremia to a certain extent,reduce the levels of phosphorus,iPTH,TNF-α,hs-CRP,is safe and reliable,and can effectively improve the quality of life of patients.