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目的:探讨血液灌流联合序贯透析对终末期糖尿病肾病(end-stage diabetic nephropathy,ESDN)患者炎症介质与氧化应激的影响。方法:选取2014年2月至2015年2月来本院进行治疗的180例ESDN患者,按照随机数字表将其分为血液透析(hemodialysis,HD)组、序贯透析(sequential dialysis,SD)组和序贯透析联合血液灌流(sequential dialysis combined with hemoperfusion,S-HFP)组,每组60例。考察治疗前后3组患者的糖代谢指标、体内炎症反应水平,评价治疗前后患者体内氧化应激状态,比较透析充分性和贫血情况。结果:3组患者的空腹血糖、餐后2 h血糖和糖化血红蛋白在治疗前后差异均无统计学意义(P>0.05)。治疗后S-HFP组患者的3项炎症因子指标显著低于其余两组(P<0.05),同时S-HFP组和SD组患者的3项炎症因子指标较治疗前显著降低(P<0.05),而HD组治疗前后炎症因子指标无变化(P>0.05)。治疗后SD组和S-HFP组患者的丙二醛(malondialdehyde,MDA)水平显著低于治疗前水平(P<0.05),而同时过氧化物歧化酶(superoxide dismutase,SOD)和谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)水平显著升高(P<0.05);HD组患者的MDA水平较治疗前显著上升(P<0.05),而SOD和GSH-Px水平显著下降(P<0.05)。3组患者在治疗前体内尿素清除指数(urea clearance index,KT/V)水平差异均无统计学意义(P>0.05),但治疗后S-HFP组患者体内Hb水平显著提高(P<0.05)。结论:对终末期糖尿病肾病患者行序贯透析联合血液灌流,可以有效滤除炎症因子,缓解患者体内氧化应激反应,改善患者贫血状况,效果显著,值得临床推广。
Objective: To investigate the effects of hemoperfusion combined with sequential dialysis on inflammatory mediators and oxidative stress in patients with end-stage diabetic nephropathy (ESDN). Methods: A total of 180 patients with ESDN who were treated in our hospital from February 2014 to February 2015 were divided into hemodialysis (HD) group, sequential dialysis (SD) group according to random number table And sequential dialysis combined with hemoperfusion (S-HFP) group, 60 cases in each group. Before and after treatment, the three groups of patients with glucose metabolism indicators, the level of inflammatory reaction in vivo before and after treatment to assess the status of oxidative stress in patients, compared dialysis adequacy and anemia. Results: There was no significant difference in fasting blood glucose, postprandial 2h blood glucose and HbA1c before and after treatment between the three groups (P> 0.05). The indexes of inflammatory cytokines in S-HFP group were significantly lower than those in the other two groups after treatment (P <0.05). The indexes of inflammatory cytokines in S-HFP group and SD group were significantly lower than those before treatment (P <0.05) , While there was no change in inflammatory index before and after treatment in HD group (P> 0.05). The levels of malondialdehyde (MDA) in SD group and S-HFP group were significantly lower than those before treatment (P <0.05), while superoxide dismutase (SOD) and glutathione (P <0.05). The level of MDA in HD group was significantly higher than that before treatment (P <0.05), while the levels of SOD and GSH-Px were significantly decreased (P <0.05) <0.05). There was no significant difference in the level of urea clearance index (KT / V) between the three groups before treatment (P> 0.05), but the levels of Hb in the S-HFP group were significantly increased after treatment (P <0.05) . Conclusion: Serial dialysis combined with hemoperfusion in patients with end stage diabetic nephropathy can effectively filter out inflammatory factors, relieve oxidative stress in patients and improve anemia in patients with significant effect, worthy of clinical promotion.