血液灌流联合序贯透析对终末期糖尿病肾病患者胰岛素抵抗及微炎症状态的影响

摘要

目的 探究血液灌流联合序贯透析对终末期糖尿病肾病患者胰岛素抵抗及微炎症状态的影响.方法 选取2015年8月至2017年1月本院收治的终末期糖尿病肾病患者92例为研究对象,按照简单随机法将其分为对照组和观察组,每组各46例,对照组患者采用血液透析联合血液透析滤过治疗,观察组患者采用血液灌流联合序贯透析治疗.检测治疗前后两组患者空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FINS)、C反应蛋白(C reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)水平及稳态模型胰岛素抵抗指数(homeostasis model of assessment-insulin resistance,HOMA-IR),并评估患者的营养状况.结果 治疗后,两组患者FPG、FINS、HOMA-IR及血清CRP、TNF-α、IL-6水平均明显低于治疗前(P<0.05),且观察组患者上述指标水平均明显低于对照组(P<0.05).治疗后,两组患者主观综合性营养评估(subjective global assessement,SGA)评分、体质指数(body mass index,BMI)、肱三头肌皮褶厚度(triceps skin-fold thickness,TSF)、血清清蛋白(albumin,ALB)、血清前清蛋白(prealbumin, PA)水平均明显高于治疗前(P<0.05),且观察组患者上述指标水平均明显高于对照组(P<0.05).结论 血液灌流联合序贯透析可有效清除终末期糖尿病肾病患者血清中的炎性介质,降低胰岛素抵抗,改善患者的营养状态.%Objective To investigate the effect of hemoperfusion combined with sequential dialysis on insulin resistance and micro inflammatory state in patients with end-stage diabetic nephropathy. Method From August 2015 to January 2017, 92 patients with end-stage diabetic nephropathy in our hospital were selected and divided into control group and observation group by the simple randomization method, and they were treated with hemodialysis combined with hemodialysis filtration and hemoperfusion combined with sequential dialysis respectively. Fasting plasma glucose (FPG), fasting insulin (FINS), C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), homeostasis model of assessment-insulin resistance (HOMA-IR) were measured before and after treatment, and nutritional status of the two groups was evaluated. Result After treatment, the levels of FPG, FINS, HOMA-IR, CRP, TNF-α and IL-6 in the two groups were lower than those before treatment (P < 0.05), while the levels of above indexes in observation group were lower than those in control group (P < 0.05). After treatment, the subjective global assessement (SGA) scores, body mass index (BMI), triceps skin-fold thickness (TSF), the levels of albumin (ALB) and prealbumin (PA) in the two groups were significantly higher than those before treatment (P<0.05), while above indexes in observation group were higher than those in control group (P<0.05). Conclusion Hemoperfusion combined with sequential dialysis can effectively remove the inflammatory mediators in the serum of patients with end-stage diabetic nephropathy, reduce insulin resistance and improve the nutritional status.