摘要:
目的 观察序贯透析联合羟乙基淀粉治疗肾病综合征顽固性水肿的疗效.方法 将88例肾病综合征顽固性水肿患者采用随机数字表法分为对照组(n=44)和联合组(n=44).对照组采用羟乙基淀粉治疗,联合组采用序贯透析联合羟乙基淀粉治疗.比较两组治疗前后24 h尿量、24 h尿蛋白及肾功能指标[血肌酐(Scr)、尿素氮(BUN)]、尿NAG酶及尿KIM-1及血清ICAM-1、TNF-α、IL-6水平的变化.并评价两组临床疗效.结果 观察组临床症状开始改善时间显著短于对照组,平均下降体质量显著大于对照组(t=7.099、9.279,P<0.05).治疗前,联合组24h尿量、24h尿蛋白及Scr、BUN水平与对照组相比,差异无统计学意义(P>0.05);与治疗前比较,两组治疗后24h尿量上升(t联合组=36.266,P<0.05;t对照组=7.906,P<0.05),而24 h尿蛋白、Scr、BUN水平下降(t联合组=21.031、25.629、26.099,均P<0.05;t对照组=9.263、6.544、5.716,均P<0.05),且联合组上述观察指标改善幅度更大(t=28.672、17.639、19.057、16.507,均P<0.05).联合组治疗有效率较对照组更高(x2=8.494,P<0.05).与治疗前比较,联合组尿NAG酶及尿KIM-1显著降低(t联合组=29.146、19.256,均P<0.05).而对照组治疗前后尿NAG酶及尿KIM-1较治疗前差异无统计学意义(P>0.05).治疗后,联合组患者血清ICAM-1、TNF-α、IL-1β水平显著低于治疗前及对照组(t联合组=15.655、16.882、16.091,均P<0.05);而对照组治疗前后ICAM-1、TNF-α、IL-1β水平差异无统计学意义(P>0.05).结论 采用序贯透析联合羟乙基淀粉治疗肾病综合征顽固性水肿,可明显提高临床疗效,改善患者肾功能,值得进一步推广.%Objective To observe the efficacy of sequential dialysis combined with hydroxyethyl starch in the treatment of patients with refractory edema of nephrotic syndrome.Methods Eighty-eight patients with refractory edema of nephrotic syndrome were randomly divided into control group (n =44) and combination group (n =44)according to the digital table.The control group was treated with hydroxyethyl starch,and the combination group was treated with sequential dialysis combined with hydroxyethyl starch.The levels of urinary NAG,urinary KIM-1 and serum ICAM-1,TNF-,IL-6 were compared.And the clinical efficacy of the two groups was evaluated.Results The improvement time of clinical symptoms in the observation group was significantly shorter than that in the control group,and the average weight loss of the observation group was significantly higher than that of the control group(t =7.099,9.279,all P < 0.05).Before treatment,the 24h urine,24h urine protein,Scr and BUN between the two groups had no statistically significant differences (all P > 0.05).Compared with before treatment,24h urine of the two groups after treatment was increased (tcombination group =36.266,P < 0.05;tcontrol group =7.906,P < 0.05),and the 24h urine protein,Scr and BUN levels of two groups were decreased after treatment (tcombination group =21.031,25.629,26.099,P <0.05;tcontrol group =9.263,6.544,5.716,all P < 0.05),and the improvement of the above indicators of the combination group was more significant (t =28.672,17.639,19.057,16.507,all P < 0.05).The effective rate of the combination group was higher than that of the control group(x2 =8.494,P < 0.05).Compared with before treatment,the urinary NAG enzyme and urinary KIM-1 of the combination group were statistically significantly decreased (tcombination group =29.146,19.256,all P < 0.05).There were no statistically significant differences in urinary NAG and urinary KIM-1 between before treatment and after treatment in the control group (all P > 0.05).After treatment,the serum levels of ICAM-1,TNF-and IL-1 β in the combination group were significantly lower than those before treatment and those in the control group (tcombination group=15.655,16.882,16.091,all P < 0.05),while there were no statistically significant differences in the serum levels of ICAM-1,TNF-and IL-1β between before treatment and after treatment in the control group (all P > 0.05).Conclusion Sequential dialysis combined with hydroxyethyl starch in the treatment of refractory edema of nephrotic syndrome can improve the clinical curative effect and improve the renal function of patients.It is worthy to be further promoted.