高通量血液透析对维持性血液透析患者胰岛素抵抗及心脏结构和功能的改善效果分析

摘要

Objective To explore the effect of high-flux hemodiafiltration( HFHD)on insulin resistance,ventricular structure and function in patients with uremia under maintenance hemodialysis. Methods Eighty-eight patients under maintenance hemodialysis were random-ly assigned to HFHD group or low flux hemodialysis( LFHD)group. There were 44 case in each group and no significant difference in parameters of insulin resistance,cardiac structure and function at the time of recruitment. Before and 6 months after the treatment,the parameters of insulin resistance( serum levels of fasting blood-glucose and insulin,adiponectin,uric acid and hs-CRP)were detected by oxidase method or radioim-munometric assay,ventricular structure and functional parameters( LAD,LVDd,LVPWT,IVST,E/A,EF and LVMI)were measured by echo-cardiogram. Results The clinical parameters of insulin resistance and the parameters of left ventricular structure and function as LAD,LVDd, LVEF and LVMI in patients of HFHD group after treatement for 6 months in comparison with those of patients in LFPD group were markedly im-proved. Conclusion High flux hemodialysis may improve the insulin resistance and alleviate the impairment of ventricular structure and function in patiets with maintenance hemodialysis-vc.%目的：探讨高通量血液透析（ HFHD）对尿毒症维持性血液透析患者的胰岛素抵抗、心脏结构及其功能的影响。方法随机将88例尿毒症维持性血液透析患者平均分为高通量透析组（ HFHD组）和低通量透析组（ LFHD组），且两组患者在胰岛素抵抗、心脏功能和相关临床症状方面无显著性差异。在治疗前和治疗6个月后分别取患者血液标本进行胰岛素抵抗情况分析，采用酶学方法检测空腹血糖和尿酸的含量，采用放射免疫分析法检测空腹胰岛素水平、脂联素、超敏C反应蛋白（ hs-CRP）等指标变化。同时采用超声心动图检测治疗前后心脏结构和功能相关指标，如左前降支（LAD）、左心室舒张末期内径（LVDd）、左心室后壁厚度（LVPWT）、舒张期室间隔厚度（IVST）、舒张早期左室充盈峰速率（ E）与心房收缩期左室充盈峰速率（ A）比值（ E/A）、左室射血分数（ EF）和左心室质量指数（ LVMI）。结果经过6个月的治疗发现，与LFHD组相比，HFHD组能显著降低尿毒症患者的空腹血糖、空腹胰岛素、尿酸和hs-CRP等指标的水平，同时能显著上调血液中脂联素水平（ P ﹤0.05）。心脏结构和功能方面，LFHD组对心脏结构和功能等指标的改善并不显著（ P ﹥0.05），而HFHD组在LAD、LVDd、EF和LVMI等方面有显著变化（ P ﹤0.05）。结论高通量血液透析有助于改善维持性血液透析患者胰岛素抵抗，同时能减轻普通血液透析所引起的心脏结构和功能损伤。